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General NPI Number Information
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NPI Number | 1548174840
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Entity Type | Organization
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Legal Business Name | GROWING ROOTS PLAY THERAPY, LLC
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Dates
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Enumeration Date | 10/01/2026
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Last Update Date | 10/01/2026
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Provider Practice Location Address
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Address Line | 907 ROCKVILLE TER
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City | LOUISBURG
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State | KS
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Zip | 66053-7812
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Country | US
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Telephone | 913-428-9819
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Fax |
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Provider Business Mailing Address
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Address Line | 907 ROCKVILLE TER
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City | LOUISBURG
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State | KS
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Zip | 66053-7812
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PLAY THERAPIST
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Name | SYDNEY OLSON
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Credential | LMSW
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Telephone | 913-428-9819
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State | NULL
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