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General NPI Number Information
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NPI Number | 1306608070
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Entity Type | Organization
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Legal Business Name | SACRED SPACE COLLECTIVE
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Dates
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Enumeration Date | 01/29/2024
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Last Update Date | 01/29/2024
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Provider Practice Location Address
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Address Line | 13359 N HIGHWAY 183 STE 406-620
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City | AUSTIN
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State | TX
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Zip | 78750-7153
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Country | US
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Telephone | 443-553-3082
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Fax | 512-503-3969
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Provider Business Mailing Address
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Address Line | 13359 N HIGHWAY 183 STE 406-620
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City | AUSTIN
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State | TX
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Zip | 78750-7153
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Country | US
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Telephone | 443-553-3082
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Fax | 512-503-3969
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Authorized Official
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Title or Position | MIDWIFE, CO-OWNER
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Name | LAUREN FOREMAN
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Credential | CNM, PMHNP
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Telephone | 443-553-3082
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number |
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License Number State |
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