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General NPI Number Information
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NPI Number | 1144071986
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Entity Type | Organization
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Legal Business Name | HEAD SPACE THERAPY CENTER
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Dates
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Enumeration Date | 03/29/2024
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Last Update Date | 08/15/2024
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Provider Practice Location Address
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Address Line | 110 LILY FLAGG RD SE
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City | HUNTSVILLE
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State | AL
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Zip | 35802
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Country | US
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Telephone | 256-501-1115
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Fax |
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Provider Business Mailing Address
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Address Line | 43 CASTLE DOWN DR SE
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City | HUNTSVILLE
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State | AL
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Zip | 35802-1293
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Country | US
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Telephone | 256-426-4173
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | JUDY CAROL PARK
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Credential | PSYD
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Telephone | 256-501-1115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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