Provider Demographics
NPI:1003335118
Name:PLAYFULLY YOU, PLLC
Entity type:Organization
Organization Name:PLAYFULLY YOU, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NATALEE
Authorized Official - Middle Name:RACHELE
Authorized Official - Last Name:TANGEN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:701-300-3525
Mailing Address - Street 1:40 1ST AVE W STE 205B
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-5103
Mailing Address - Country:US
Mailing Address - Phone:701-300-3525
Mailing Address - Fax:701-491-7530
Practice Address - Street 1:40 1ST AVE W STE 205B
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-5103
Practice Address - Country:US
Practice Address - Phone:701-300-3525
Practice Address - Fax:701-491-7530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND43381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1454380Medicaid