Healthcare Provider Details

I. General information

NPI: 1376219212
Provider Name (Legal Business Name): WEE PLAY FAMILY THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2021
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 N 750 W
KOKOMO IN
46901-8506
US

IV. Provider business mailing address

PO BOX 173
FLORA IN
46929-0173
US

V. Phone/Fax

Practice location:
  • Phone: 765-434-0425
  • Fax:
Mailing address:
  • Phone: 765-416-3422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRITTANIE ALYN SPRAKER
Title or Position: OWNER
Credential: LMFT, RPT
Phone: 765-416-3422