Basic Information
| Provider Information | |||||||||
| NPI: | 1598082596 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NOLA PLAY THERAPY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6744 | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701746744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043097844 | ||||||||
| FaxNumber: | 5043097845 | ||||||||
| Practice Location | |||||||||
| Address1: | 122 SIERRA CT | ||||||||
| Address2: | |||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700015326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3373804339 | ||||||||
| FaxNumber: | 5043097845 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2010 | ||||||||
| LastUpdateDate: | 04/29/2010 | ||||||||
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| AuthorizedOfficialLastName: | LOLAN | ||||||||
| AuthorizedOfficialFirstName: | ADRIANNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3373804339 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 4425 | LA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.