Provider Demographics
NPI:1356175426
Name:PAX HOUSE COUNSELING AND PLAY THERAPY LLC
Entity type:Organization
Organization Name:PAX HOUSE COUNSELING AND PLAY THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LIRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PESHKEPIA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:662-471-4055
Mailing Address - Street 1:210 E MAIN ST STE 2B
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-4017
Mailing Address - Country:US
Mailing Address - Phone:662-471-4055
Mailing Address - Fax:
Practice Address - Street 1:210 E MAIN ST STE 2B
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-4017
Practice Address - Country:US
Practice Address - Phone:662-471-4055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty