Provider Demographics
NPI:1699290536
Name:CREATIVE PLAY & FAMILY COUNSELING
Entity type:Organization
Organization Name:CREATIVE PLAY & FAMILY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:P
Authorized Official - Last Name:PSIHOGIOS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, RPT
Authorized Official - Phone:484-802-7557
Mailing Address - Street 1:624 RENZ ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-1419
Mailing Address - Country:US
Mailing Address - Phone:484-802-7557
Mailing Address - Fax:
Practice Address - Street 1:233 E LANCASTER AVE STE 104
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-2321
Practice Address - Country:US
Practice Address - Phone:215-483-1360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-11
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA007248261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)