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General NPI Number Information
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NPI Number | 1831631597
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Entity Type | Organization
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Legal Business Name | OK 2 PLAYY
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Dates
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Enumeration Date | 11/12/2016
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Last Update Date | 01/17/2017
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Provider Practice Location Address
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Address Line | 16000 W 9 MILE RD 112
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4808
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Country | US
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Telephone | 248-802-0342
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Fax | 248-355-5673
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Provider Business Mailing Address
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Address Line | 16000 W 9 MILE RD 112
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4808
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Country | US
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Telephone | 248-802-8003
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Fax | 248-355-5673
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Authorized Official
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Title or Position | THERAPIST
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Name | LELA ANN STOVALL
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Credential | LLPC
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Telephone | 314-743-1574
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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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 | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6401014828
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License Number State | MI
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