Healthcare Provider Details

I. General information

NPI: 1679402846
Provider Name (Legal Business Name): HEADSPACE MEDICAL GROUP MI PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 MARKET ST FL 7
SAN FRANCISCO CA
94105-2802
US

IV. Provider business mailing address

595 MARKET ST FL 7
SAN FRANCISCO CA
94105-2802
US

V. Phone/Fax

Practice location:
  • Phone: 832-235-4476
  • Fax:
Mailing address:
  • Phone:
  • 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: SOPHIE XU
Title or Position: SENIOR DIRECTOR, RCM AND PAYER OPS
Credential:
Phone: 832-235-4476