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General NPI Number Information
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NPI Number | 1730053737
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Entity Type | Organization
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Legal Business Name | MISSOULA PLAY THERAPY LLC
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Dates
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Enumeration Date | 10/02/2025
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 500 N HIGGINS AVE STE 200
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City | MISSOULA
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State | MT
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Zip | 59802-4550
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Country | US
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Telephone | 817-247-6335
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Fax |
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Provider Business Mailing Address
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Address Line | 538 EDDY AVE APT A
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City | MISSOULA
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State | MT
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Zip | 59801-2803
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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 | CLINICIAN
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Name | ROBIN CHERNOFF
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Credential | LCPC
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Telephone | 817-247-6335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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