Provider Demographics
NPI: | 1174624670 |
---|---|
Name: | OXFORD PLAY THERAPY TRAINING INSTITUTE |
Entity type: | Organization |
Organization Name: | OXFORD PLAY THERAPY TRAINING INSTITUTE |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | MARILYN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SNOW |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PHD, LPC |
Authorized Official - Phone: | 662-234-6848 |
Mailing Address - Street 1: | PO BOX 1570 |
Mailing Address - Street 2: | |
Mailing Address - City: | OXFORD |
Mailing Address - State: | MS |
Mailing Address - Zip Code: | 38655-1570 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 662-234-6848 |
Mailing Address - Fax: | 662-234-9792 |
Practice Address - Street 1: | 2653 W OXFORD LOOP |
Practice Address - Street 2: | SUITE 104 |
Practice Address - City: | OXFORD |
Practice Address - State: | MS |
Practice Address - Zip Code: | 38655-5442 |
Practice Address - Country: | US |
Practice Address - Phone: | 662-234-6848 |
Practice Address - Fax: | 662-234-9792 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-09-26 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Single Specialty |