Provider Demographics
NPI:1144864943
Name:CONIFER PLAY THERAPY, LLC
Entity type:Organization
Organization Name:CONIFER PLAY THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:720-323-9219
Mailing Address - Street 1:26719 PLEASANT PARK RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433-7753
Mailing Address - Country:US
Mailing Address - Phone:720-323-9219
Mailing Address - Fax:
Practice Address - Street 1:26719 PLEASANT PARK RD STE 100
Practice Address - Street 2:
Practice Address - City:CONIFER
Practice Address - State:CO
Practice Address - Zip Code:80433-7753
Practice Address - Country:US
Practice Address - Phone:720-323-9219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO969976Medicaid
1013446269OtherUNITED HEALTHCARE