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General NPI Number Information
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NPI Number | 1750250007
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Entity Type | Organization
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Legal Business Name | PLAYBLOOM THERAPY COLLABORATIVE, LLC
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Dates
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Enumeration Date | 11/04/2025
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Last Update Date | 11/06/2025
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Provider Practice Location Address
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Address Line | 9501 HILLWOOD DR
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City | LAS VEGAS
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State | NV
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Zip | 89134-0527
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Country | US
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Telephone | 702-273-8254
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Fax |
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Provider Business Mailing Address
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Address Line | 9501 HILLWOOD DR
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City | LAS VEGAS
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State | NV
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Zip | 89134-0527
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Country | US
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Telephone | 702-273-8254
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Fax |
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Authorized Official
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Title or Position | OWNER/FOUNDER
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Name | AMY NOVAK
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Credential |
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Telephone | 702-273-8254
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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