Healthcare Provider Details

I. General information

NPI: 1689585648
Provider Name (Legal Business Name): PLAY SPACE CHILD COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 LOOKOUT PL STE 200
MAITLAND FL
32751-8408
US

IV. Provider business mailing address

220 LOOKOUT PL STE 200
MAITLAND FL
32751-8408
US

V. Phone/Fax

Practice location:
  • Phone: 407-403-7462
  • Fax:
Mailing address:
  • Phone: 407-403-7462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SARAH BURGOS
Title or Position: OWNER
Credential: LMHC
Phone: 407-403-7462