Provider Demographics
NPI:1194092882
Name:OHALLORAN PLAY THERAPY & FAMILY GROWTH CENTER
Entity type:Organization
Organization Name:OHALLORAN PLAY THERAPY & FAMILY GROWTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:O'HALLORAN
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW
Authorized Official - Phone:316-283-1142
Mailing Address - Street 1:120 W 6TH ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-2155
Mailing Address - Country:US
Mailing Address - Phone:316-283-1142
Mailing Address - Fax:316-283-1142
Practice Address - Street 1:120 W 6TH ST
Practice Address - Street 2:SUITE 140
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-2155
Practice Address - Country:US
Practice Address - Phone:316-283-1142
Practice Address - Fax:316-283-1142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-23
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2429251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health