Provider Demographics
NPI:1922587328
Name:EASTSIDE PLAY THERAPY
Entity Type:Organization
Organization Name:EASTSIDE PLAY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LMHC, RPT-S
Authorized Official - Phone:405-919-5089
Mailing Address - Street 1:13401 BEL-RED ROAD NE STE B-12
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005
Mailing Address - Country:US
Mailing Address - Phone:206-350-7506
Mailing Address - Fax:206-582-7030
Practice Address - Street 1:13401 BEL-RED ROAD NE STE B-12
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2945
Practice Address - Country:US
Practice Address - Phone:206-350-7506
Practice Address - Fax:206-582-7030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-07
Last Update Date:2023-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60579749101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty