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General NPI Number Information
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NPI Number | 1144021015
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Entity Type | Organization
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Legal Business Name | PLAYFUL POSSIBILITIES CHILD AND FAMILY THERAPY, LLC
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Dates
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Enumeration Date | 03/24/2025
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 4601 EXCELSIOR BLVD STE 403
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City | SAINT LOUIS PARK
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State | MN
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Zip | 55416-4977
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Country | US
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Telephone | 612-293-9056
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Fax |
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Provider Business Mailing Address
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Address Line | 4601 EXCELSIOR BLVD STE 403
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City | SAINT LOUIS PARK
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State | MN
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Zip | 55416-4977
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Country | US
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Telephone | 612-293-9056
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Fax |
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | LAUREN HAYES VANCHINA
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Credential | LICSW
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Telephone | 716-604-8607
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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