Provider Demographics
NPI:1649008475
Name:PLAYHOUSE COLLABORATIVE
Entity type:Organization
Organization Name:PLAYHOUSE COLLABORATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BONNER-HORON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC, RPT-S, ACS
Authorized Official - Phone:618-292-5957
Mailing Address - Street 1:500 HUBER PARK CT STE 106
Mailing Address - Street 2:
Mailing Address - City:WELDON SPRING
Mailing Address - State:MO
Mailing Address - Zip Code:63304-8683
Mailing Address - Country:US
Mailing Address - Phone:636-344-0580
Mailing Address - Fax:
Practice Address - Street 1:500 HUBER PARK CT STE 106
Practice Address - Street 2:
Practice Address - City:WELDON SPRING
Practice Address - State:MO
Practice Address - Zip Code:63304-8683
Practice Address - Country:US
Practice Address - Phone:636-344-0580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty