Provider Demographics
NPI:1962949057
Name:SOL PLAY CHILD THERAPY, INC
Entity type:Organization
Organization Name:SOL PLAY CHILD THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMFT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLA
Authorized Official - Middle Name:
Authorized Official - Last Name:DE MAGALHAES
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:619-797-6595
Mailing Address - Street 1:8453 LA MESA BLVD
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942
Mailing Address - Country:US
Mailing Address - Phone:619-797-6595
Mailing Address - Fax:888-975-4199
Practice Address - Street 1:8453 LA MESA BLVD
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942
Practice Address - Country:US
Practice Address - Phone:619-797-6595
Practice Address - Fax:888-975-4199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-26
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82947302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization