Provider Demographics
NPI:1982317517
Name:SUNSHINE PLAY THERAPY AND COUNSELING
Entity Type:Organization
Organization Name:SUNSHINE PLAY THERAPY AND COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMPLE
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC, RPT
Authorized Official - Phone:361-782-1576
Mailing Address - Street 1:606 N WELLS ST
Mailing Address - Street 2:
Mailing Address - City:EDNA
Mailing Address - State:TX
Mailing Address - Zip Code:77957-2719
Mailing Address - Country:US
Mailing Address - Phone:361-782-1576
Mailing Address - Fax:361-298-2363
Practice Address - Street 1:606 N WELLS ST
Practice Address - Street 2:
Practice Address - City:EDNA
Practice Address - State:TX
Practice Address - Zip Code:77957-2719
Practice Address - Country:US
Practice Address - Phone:361-782-1576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX410677502Medicaid