Healthcare Provider Details

I. General information

NPI: 1174305841
Provider Name (Legal Business Name): PLAY BY PLAY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2023
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4405 7TH AVE SE
LACEY WA
98503-1062
US

IV. Provider business mailing address

4405 7TH AVE SE STE 200
LACEY WA
98503-1055
US

V. Phone/Fax

Practice location:
  • Phone: 253-904-2324
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MAECHELL RITTER
Title or Position: OWNER/CHILD THERAPIST
Credential: LICSW
Phone: 253-904-2324