Healthcare Provider Details

I. General information

NPI: 1932773918
Provider Name (Legal Business Name): HEADSPACE COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2021
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1568 LAKE LANSING RD
LANSING MI
48912-3707
US

IV. Provider business mailing address

1578 PICADILLY DR
HASLETT MI
48840-8480
US

V. Phone/Fax

Practice location:
  • Phone: 517-657-3533
  • Fax:
Mailing address:
  • Phone: 517-993-8072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ASHITA GHELANI
Title or Position: BUSINESS OWNER
Credential:
Phone: 517-974-4726