Provider Demographics
NPI:1992101265
Name:MONARCH PLAY THERAPY, LLC
Entity type:Organization
Organization Name:MONARCH PLAY THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW
Authorized Official - Phone:785-218-1829
Mailing Address - Street 1:947 NEW HAMPSHIRE ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-3073
Mailing Address - Country:US
Mailing Address - Phone:785-218-1829
Mailing Address - Fax:
Practice Address - Street 1:947 NEW HAMPSHIRE ST
Practice Address - Street 2:SUITE 209
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-3073
Practice Address - Country:US
Practice Address - Phone:785-218-1829
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS43831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200860730BMedicaid