Provider Demographics
NPI:1831631597
Name:OK 2 PLAYY
Entity type:Organization
Organization Name:OK 2 PLAYY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LELA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:STOVALL
Authorized Official - Suffix:
Authorized Official - Credentials:LLPC
Authorized Official - Phone:314-743-1574
Mailing Address - Street 1:16000 W 9 MILE RD
Mailing Address - Street 2:112
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4808
Mailing Address - Country:US
Mailing Address - Phone:248-802-8003
Mailing Address - Fax:248-355-5673
Practice Address - Street 1:16000 W 9 MILE RD
Practice Address - Street 2:112
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4808
Practice Address - Country:US
Practice Address - Phone:248-802-0342
Practice Address - Fax:248-355-5673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-12
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
305R00000X, 343900000X
MI6401014828101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No305R00000XManaged Care OrganizationsPreferred Provider OrganizationGroup - Multi-Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)