Healthcare Provider Details

I. General information

NPI: 1508159773
Provider Name (Legal Business Name): KID'S THERAPLAY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2011
Last Update Date: 11/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 PARK STREET SUITE 281
CUMBERLAND MD
21502
US

IV. Provider business mailing address

725 PARK STREET SUITE 281
CUMBERLAND MD
21502
US

V. Phone/Fax

Practice location:
  • Phone: 301-202-7012
  • Fax: 321-452-2802
Mailing address:
  • Phone: 301-202-7012
  • Fax: 321-452-2802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH7949
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC2309
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberMH7949
License Number StateFL

VIII. Authorized Official

Name: MRS. TAMMY STAR
Title or Position: OWNER/THERAPIST
Credential: LMHC/LPC
Phone: 301-202-7012