Provider Demographics
NPI:1770819385
Name:KIDS AT PLAY THERAPY, LLC
Entity type:Organization
Organization Name:KIDS AT PLAY THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:L
Authorized Official - Last Name:O'CALLAGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-447-8216
Mailing Address - Street 1:16501 64TH ST E STE D
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-3001
Mailing Address - Country:US
Mailing Address - Phone:253-447-8216
Mailing Address - Fax:253-447-8789
Practice Address - Street 1:16501 64TH ST E STE D
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-3001
Practice Address - Country:US
Practice Address - Phone:253-447-8216
Practice Address - Fax:253-447-8789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602939253174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty