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General NPI Number Information
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NPI Number | 1861752503
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Entity Type | Organization
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Legal Business Name | SPIRITPLAY COUNSELING CENTER, LLC
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Dates
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Enumeration Date | 05/28/2012
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Last Update Date | 05/28/2012
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Provider Practice Location Address
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Address Line | 12211 W BELL RD STE 109
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City | SURPRISE
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State | AZ
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Zip | 85378-9655
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Country | US
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Telephone | 623-972-5900
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Fax | 623-972-5919
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Provider Business Mailing Address
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Address Line | 12211 W BELL RD STE 109
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City | SURPRISE
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State | AZ
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Zip | 85378-9655
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Country | US
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Telephone | 623-972-5900
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JUDITH ANN LANGREDER
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Credential | MA, LPC, NCC
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Telephone | 623-332-6150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LPC10833
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License Number State | AZ
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