Basic Information
| Provider Information | |||||||||
| NPI: | 1447301890 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BEYOND PLAY THERAPY GROUP, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 13861 | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392363861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6016055384 | ||||||||
| FaxNumber: | 6018984761 | ||||||||
| Practice Location | |||||||||
| Address1: | 665 HIGHWAY 51 STE C | ||||||||
| Address2: | |||||||||
| City: | RIDGELAND | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391572136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6016055384 | ||||||||
| FaxNumber: | 6018984761 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LINDSAY | ||||||||
| AuthorizedOfficialFirstName: | JUDY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6016055384 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235500000X | PT1279 | MS | Y | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Specialist/Technologist |
ID Information
| ID | Type | State | Issuer | Description | 06081560 | 05 | MS | MEDICAID |