Provider Demographics
NPI:1124998927
Name:PLAYFUL MINDS ABA, LLC
Entity type:Organization
Organization Name:PLAYFUL MINDS ABA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THESSALIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAEWEATHER
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LBA
Authorized Official - Phone:682-390-5316
Mailing Address - Street 1:4008 S POLK ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-4925
Mailing Address - Country:US
Mailing Address - Phone:682-390-5316
Mailing Address - Fax:945-293-2818
Practice Address - Street 1:4008 S POLK ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-4925
Practice Address - Country:US
Practice Address - Phone:682-390-5316
Practice Address - Fax:945-293-2818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-06
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty