Organization
HORSE PLAY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTINE PROCTOR LMSW (OWNER)
(269) 405-0653
Entity
Organization
Contact information
Practice address
2820 NILES RD, SAINT JOSEPH, MI 49085-3338
(269) 405-0653
Mailing address
2820 NILES RD, SAINT JOSEPH, MI 49085-3338
(269) 405-0653
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301013553
MI
1041C0700X
Clinical Social Worker
6801069783
MI
Other
Enumeration date
08/17/2010
Last updated
08/17/2010
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