Provider Demographics
NPI:1598427890
Name:ASNIICIYAPI PLAY THERAPY & COUNSELING SERVICES
Entity Type:Organization
Organization Name:ASNIICIYAPI PLAY THERAPY & COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JOHANSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:605-864-0891
Mailing Address - Street 1:48251 229TH ST
Mailing Address - Street 2:
Mailing Address - City:FLANDREAU
Mailing Address - State:SD
Mailing Address - Zip Code:57028-6602
Mailing Address - Country:US
Mailing Address - Phone:605-864-0891
Mailing Address - Fax:
Practice Address - Street 1:48251 229TH ST
Practice Address - Street 2:
Practice Address - City:FLANDREAU
Practice Address - State:SD
Practice Address - Zip Code:57028-6602
Practice Address - Country:US
Practice Address - Phone:605-864-0891
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health