Healthcare Provider Details

I. General information

NPI: 1639985237
Provider Name (Legal Business Name): THERAPLAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 12/09/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1067 W 1360 S
OREM UT
84058
US

IV. Provider business mailing address

336 E UNIVERSITY PKWY # 1099
OREM UT
84058-7602
US

V. Phone/Fax

Practice location:
  • Phone: 385-200-1034
  • Fax:
Mailing address:
  • Phone: 385-200-1034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ALYSSA KERBY
Title or Position: OWNER
Credential:
Phone: 385-321-1149