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General NPI Number Information
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NPI Number | 1962890376
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Entity Type | Organization
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Legal Business Name | GO PLAY THERAPY CENTER, LLC
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Dates
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Enumeration Date | 01/07/2015
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Last Update Date | 01/07/2015
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Provider Practice Location Address
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Address Line | 2804 GREENHILL BLVD NW
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City | FORT PAYNE
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State | AL
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Zip | 35968-3066
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Country | US
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Telephone | 256-979-1222
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Fax | 256-979-1223
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Provider Business Mailing Address
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Address Line | 66 COUNTY ROAD 100
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City | FYFFE
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State | AL
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Zip | 35971-5161
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Country | US
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Telephone | 265-979-1222
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Fax | 256-979-1223
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Authorized Official
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Title or Position | OWNER/ MANAGER
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Name | SILVIA HERNANDEZ
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Credential |
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Telephone | 256-979-1222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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