Provider Demographics
NPI:1023836715
Name:KMG PLAY THERAPY, LLC
Entity type:Organization
Organization Name:KMG PLAY THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHILD THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KALLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GETTINGER
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW, RPT-S
Authorized Official - Phone:913-735-9291
Mailing Address - Street 1:9306 W 146TH PL
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66221-2258
Mailing Address - Country:US
Mailing Address - Phone:913-735-9291
Mailing Address - Fax:
Practice Address - Street 1:15064 ANTIOCH RD
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66221-8502
Practice Address - Country:US
Practice Address - Phone:913-735-9291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty