Provider Demographics
NPI: | 1770819385 |
---|---|
Name: | KIDS AT PLAY THERAPY, LLC |
Entity Type: | Organization |
Organization Name: | KIDS AT PLAY THERAPY, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | TANYA |
Authorized Official - Middle Name: | L |
Authorized Official - Last Name: | O'CALLAGHAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 253-447-8216 |
Mailing Address - Street 1: | 16501 64TH ST E STE D |
Mailing Address - Street 2: | |
Mailing Address - City: | SUMNER |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 98390-3001 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 253-447-8216 |
Mailing Address - Fax: | 253-447-8789 |
Practice Address - Street 1: | 16501 64TH ST E STE D |
Practice Address - Street 2: | |
Practice Address - City: | SUMNER |
Practice Address - State: | WA |
Practice Address - Zip Code: | 98390-3001 |
Practice Address - Country: | US |
Practice Address - Phone: | 253-447-8216 |
Practice Address - Fax: | 253-447-8789 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-11-02 |
Last Update Date: | 2009-11-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WA | 602939253 | 174400000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 174400000X | Other Service Providers | Specialist | Group - Single Specialty |