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General NPI Number Information
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NPI Number | 1033696265
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Entity Type | Organization
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Legal Business Name | SELF SPACE, PLLC
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Dates
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Enumeration Date | 07/20/2018
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Last Update Date | 07/20/2018
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Provider Practice Location Address
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Address Line | 7220 WOODLAWN AVE NE # 306
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City | SEATTLE
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State | WA
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Zip | 98115-5336
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Country | US
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Telephone | 206-799-0712
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Fax |
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Provider Business Mailing Address
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Address Line | 10245 36TH AVE SW
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City | SEATTLE
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State | WA
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Zip | 98146-1111
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Country | US
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Telephone | 206-799-0712
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MRS. RACHEL E LUND
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Credential | LMHC
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Telephone | 206-799-0712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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