MEDICARE: LETS PLAY PSYCHOTHERAPY SERVICES

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1689275976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LETS PLAY PSYCHOTHERAPY SERVICES

Provider Business Mailing Address
First Line	:	712 H ST NE # 1545
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20002-3627
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	712 H ST NE # 1545
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20002-3627
Country	:	US
Telephone Number	:	240-839-1774
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. MONIQUE JUNE DOUGLASS
Credential	:	LMFT
Telephone Number	:	240-839-1774

Provider Enumeration Date	:	11/04/2020
Last Update Date	:	11/04/2020

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Directions to “LETS PLAY PSYCHOTHERAPY SERVICES ” Practice Location

Language	Start Address	Practice Location

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