Healthcare Provider Details

I. General information

NPI: 1447301890
Provider Name (Legal Business Name): BEYOND PLAY THERAPY GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 HIGHWAY 51 STE C
RIDGELAND MS
39157-2136
US

IV. Provider business mailing address

PO BOX 13861
JACKSON MS
39236-3861
US

V. Phone/Fax

Practice location:
  • Phone: 601-605-5384
  • Fax: 601-898-4761
Mailing address:
  • Phone: 601-605-5384
  • Fax: 601-898-4761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235500000X
TaxonomySpeech/Language/Hearing Specialist/Technologist
License NumberPT1279
License Number StateMS

VIII. Authorized Official

Name: JUDY LINDSAY
Title or Position: OWNER
Credential: PT
Phone: 601-605-5384