=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255203758
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NURTURING ROOTS PLAY THERAPY, PLLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2025
-----------------------------------------------------
Last Update Date | 09/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 AUSTIN AVE STE 25
-----------------------------------------------------
City | WACO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76701-2044
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-252-5053
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 600 AUSTIN AVE STE 25
-----------------------------------------------------
City | WACO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76701-2044
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-252-5053
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PROFESSIONAL COUNSELOR
-----------------------------------------------------
Name | MRS. TANIA F. OLIVARRI
-----------------------------------------------------
Credential | MS, LPC, NCC
-----------------------------------------------------
Telephone | 254-252-5053
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------