Healthcare Provider Details

I. General information

NPI: 1003672080
Provider Name (Legal Business Name): PLAY-BASED WELLNESS BEHAVIORAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 S ALLEN HEIGHTS DR
ALLEN TX
75002-3993
US

IV. Provider business mailing address

208 N ALLEN HEIGHTS DR
ALLEN TX
75002-2316
US

V. Phone/Fax

Practice location:
  • Phone: 469-228-8143
  • Fax: 469-242-9708
Mailing address:
  • Phone: 469-228-8143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: ANNA OSIPOVA
Title or Position: FOUNDING CLINICIAN
Credential: BCBA
Phone: 773-726-0773