Provider Demographics
NPI:1316324635
Name:TWIN CITIES PLAY THERAPY CENTER
Entity type:Organization
Organization Name:TWIN CITIES PLAY THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BULGATZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:651-452-2305
Mailing Address - Street 1:3440 FEDERAL DR STE 150
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-3516
Mailing Address - Country:US
Mailing Address - Phone:651-452-2305
Mailing Address - Fax:651-452-2796
Practice Address - Street 1:3440 FEDERAL DR STE 150
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-3516
Practice Address - Country:US
Practice Address - Phone:651-452-2305
Practice Address - Fax:651-452-2796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health