Provider Demographics
NPI:1912256496
Name:FAMILY CHANGES PLAY THERAPY, PLLC
Entity type:Organization
Organization Name:FAMILY CHANGES PLAY THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCNAUGHT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S, RPT-S
Authorized Official - Phone:210-202-1999
Mailing Address - Street 1:28580 INTERSTATE 10 W
Mailing Address - Street 2:SUITE # 4
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-9105
Mailing Address - Country:US
Mailing Address - Phone:210-202-1999
Mailing Address - Fax:888-723-1795
Practice Address - Street 1:28580 INTERSTATE 10 W
Practice Address - Street 2:SUITE # 4
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-9105
Practice Address - Country:US
Practice Address - Phone:210-202-1999
Practice Address - Fax:888-723-1795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-30
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19681101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty