=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023752474
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PLAYFUL CONNECTIONS COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2022
-----------------------------------------------------
Last Update Date | 04/22/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 220 PARK PL STE 201
-----------------------------------------------------
City | COVINGTON
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70433-5267
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-898-2999
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 349 WINCHESTER CIR
-----------------------------------------------------
City | MANDEVILLE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70448-1938
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-232-0257
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MORGAN T WHITE
-----------------------------------------------------
Credential | MA, LPC
-----------------------------------------------------
Telephone | 504-232-0257
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0855X
-----------------------------------------------------
Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------