Provider Demographics
NPI:1851059828
Name:LAUGHING HEART PLAY THERAPY LLC
Entity Type:Organization
Organization Name:LAUGHING HEART PLAY THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HECTOR
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:510-759-6221
Mailing Address - Street 1:2000 ENGEL ST STE 103
Mailing Address - Street 2:
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53713-4822
Mailing Address - Country:US
Mailing Address - Phone:510-759-6221
Mailing Address - Fax:
Practice Address - Street 1:2000 ENGEL ST STE 103
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53713-4822
Practice Address - Country:US
Practice Address - Phone:510-759-6221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-07
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health