Healthcare Provider Details

I. General information

NPI: 1174624670
Provider Name (Legal Business Name): OXFORD PLAY THERAPY TRAINING INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2653 W OXFORD LOOP SUITE 104
OXFORD MS
38655-5442
US

IV. Provider business mailing address

PO BOX 1570
OXFORD MS
38655-1570
US

V. Phone/Fax

Practice location:
  • Phone: 662-234-6848
  • Fax: 662-234-9792
Mailing address:
  • Phone: 662-234-6848
  • Fax: 662-234-9792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. MARILYN SNOW
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD, LPC
Phone: 662-234-6848