MEDICARE: PLAY BY PLAY COUNSELING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1174305841
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLAY BY PLAY COUNSELING

Provider Business Mailing Address
First Line	:	4405 7TH AVE SE STE 200
Second Line	:
City	:	LACEY
State	:	WA
Zip	:	98503-1055
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4405 7TH AVE SE
Second Line	:
City	:	LACEY
State	:	WA
Zip	:	98503-1062
Country	:	US
Telephone Number	:	253-904-2324
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CHILD THERAPIST
Name	:	MAECHELL RITTER
Credential	:	LICSW
Telephone Number	:	253-904-2324

Provider Enumeration Date	:	10/17/2023
Last Update Date	:	10/17/2023

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Directions to “PLAY BY PLAY COUNSELING ” Practice Location

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