Healthcare Provider Details

I. General information

NPI: 1205707577
Provider Name (Legal Business Name): SAFE SPACE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 CEDAR HEIGHTS DR
CEDAR FALLS IA
50613-6041
US

IV. Provider business mailing address

3301 CEDAR HEIGHTS DR
CEDAR FALLS IA
50613-6041
US

V. Phone/Fax

Practice location:
  • Phone: 319-493-7613
  • Fax: 319-249-0508
Mailing address:
  • Phone: 319-493-7613
  • Fax: 319-249-0508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: NICHELLE CATHERINE BLAKESLEY
Title or Position: OWNER
Credential: LISW
Phone: 319-493-7613