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General NPI Number Information
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NPI Number | 1275157224
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Entity Type | Organization
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Legal Business Name | HOLDING SPACE THERAPY, LLC
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Dates
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Enumeration Date | 06/05/2020
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Last Update Date | 03/21/2024
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Provider Practice Location Address
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Address Line | N2440 ARA GLEN DR STE 203
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City | LAKE GENEVA
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State | WI
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Zip | 53147-3736
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Country | US
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Telephone | 651-564-8456
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Fax |
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Provider Business Mailing Address
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Address Line | N2440 ARA GLEN DR STE 203
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City | LAKE GENEVA
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State | WI
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Zip | 53147-3736
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Country | US
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Telephone | 651-564-8456
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Fax |
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Authorized Official
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Title or Position | MARRIAGE AND FAMILY THERAPIST
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Name | CANDACE RUTKOWSKI
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Credential | MA, LMFT, RPT
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Telephone | 651-564-8456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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