Healthcare Provider Details

I. General information

NPI: 1831631597
Provider Name (Legal Business Name): OK 2 PLAYY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2016
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16000 W 9 MILE RD 112
SOUTHFIELD MI
48075-4808
US

IV. Provider business mailing address

16000 W 9 MILE RD 112
SOUTHFIELD MI
48075-4808
US

V. Phone/Fax

Practice location:
  • Phone: 248-802-0342
  • Fax: 248-355-5673
Mailing address:
  • Phone: 248-802-8003
  • Fax: 248-355-5673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401014828
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: LELA ANN STOVALL
Title or Position: THERAPIST
Credential: LLPC
Phone: 314-743-1574