Healthcare Provider Details

I. General information

NPI: 1861252538
Provider Name (Legal Business Name): THERAPYSPACE, BY SILVER HOUSE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 12/01/2024
Certification Date: 12/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13507 N 145TH DR
SURPRISE AZ
85379-6162
US

IV. Provider business mailing address

13507 N 145TH DR
SURPRISE AZ
85379-6162
US

V. Phone/Fax

Practice location:
  • Phone: 202-681-1274
  • Fax: 480-607-7003
Mailing address:
  • Phone: 202-681-1274
  • Fax: 480-607-7003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2081P0301X
TaxonomyBrain Injury Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: ASPEN DECKER
Title or Position: CEO
Credential:
Phone: 202-681-1274