Provider Demographics
NPI:1578008405
Name:COUNSELING AND PLAY THERAPY CENTER LLC
Entity Type:Organization
Organization Name:COUNSELING AND PLAY THERAPY CENTER LLC
Other - Org Name:ROSE M HARRIET, LPC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARRIET
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:307-217-2161
Mailing Address - Street 1:427 N ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:WY
Mailing Address - Zip Code:82834-1712
Mailing Address - Country:US
Mailing Address - Phone:307-217-2161
Mailing Address - Fax:307-684-9037
Practice Address - Street 1:140 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:WY
Practice Address - Zip Code:82834-1846
Practice Address - Country:US
Practice Address - Phone:307-217-2161
Practice Address - Fax:307-684-9037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-02
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY807101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty