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General NPI Number Information
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NPI Number | 1255930392
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Entity Type | Organization
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Legal Business Name | THE THERAPY SPACE LLC
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Dates
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Enumeration Date | 10/20/2020
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Last Update Date | 10/20/2020
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Provider Practice Location Address
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Address Line | 1084 E LANCASTER AVE STE 301
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City | BRYN MAWR
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State | PA
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Zip | 19010-1515
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Country | US
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Telephone | 267-254-1175
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Fax |
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Provider Business Mailing Address
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Address Line | 8201 HENRY AVE APT Q9
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City | PHILADELPHIA
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State | PA
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Zip | 19128-2250
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Country | US
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Telephone | 267-254-1175
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PATRICIA L EVANS
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Credential | LPC
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Telephone | 267-254-1175
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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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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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