Healthcare Provider Details

I. General information

NPI: 1336004944
Provider Name (Legal Business Name): YOUR SPACE COUNSELING GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 MAPLE ST STE I
AUBURN CA
95603-5041
US

IV. Provider business mailing address

1085 FAITH DR
MEADOW VISTA CA
95722-9554
US

V. Phone/Fax

Practice location:
  • Phone: 916-233-6604
  • Fax: 916-233-6604
Mailing address:
  • Phone: 916-233-6604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA SHAVER
Title or Position: PRESIDENT
Credential: MFT
Phone: 916-233-6604