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General NPI Number Information
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NPI Number | 1215862404
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Entity Type | Organization
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Legal Business Name | MY HEALING SPACE COUNSELING PLLC
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Dates
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Enumeration Date | 06/17/2026
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Last Update Date | 06/17/2026
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Provider Practice Location Address
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Address Line | 14211 E 4TH AVE BLDG 3
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City | AURORA
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State | CO
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Zip | 80011-8736
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Country | US
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Telephone | 720-829-4471
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Fax | 720-829-4478
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Provider Business Mailing Address
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Address Line | 19549 RANDOLPH PL
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City | DENVER
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State | CO
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Zip | 80249-8609
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Country | US
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Telephone | 720-829-4471
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Fax | 720-829-4478
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Authorized Official
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Title or Position | OWNER
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Name | FANNIE JOHNSON
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Credential | CAS
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Telephone | 720-209-8897
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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