Provider Demographics
NPI:1841507142
Name:HORSEPLAY PRODUCTIONS HEALING CENTER, INC.
Entity type:Organization
Organization Name:HORSEPLAY PRODUCTIONS HEALING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BRADSTREAM
Authorized Official - Suffix:
Authorized Official - Credentials:MS, EAGALA CERTIFIED
Authorized Official - Phone:605-343-1620
Mailing Address - Street 1:PO BOX 276
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57709-0276
Mailing Address - Country:US
Mailing Address - Phone:805-343-1620
Mailing Address - Fax:605-343-1629
Practice Address - Street 1:1101 E. PHILADELPHIA STREET
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701
Practice Address - Country:US
Practice Address - Phone:805-343-1620
Practice Address - Fax:605-343-1629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD102274101Y00000X
SDLPC1102101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty