Healthcare Provider Details

I. General information

NPI: 1902590359
Provider Name (Legal Business Name): PLAYGROUND OF LIFE THERAPEUTIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 CLOVIS AVE
CLOVIS CA
93612-1115
US

IV. Provider business mailing address

PO BOX 1950
OAKHURST CA
93644-1950
US

V. Phone/Fax

Practice location:
  • Phone: 559-760-4341
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: ALLISON RESSLER
Title or Position: LMFT
Credential: LMFT
Phone: 559-760-4341