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General NPI Number Information
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NPI Number | 1336803097
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Entity Type | Organization
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Legal Business Name | SAFE SPACE MENTAL HEALTH LLC
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Dates
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Enumeration Date | 10/28/2021
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Last Update Date | 11/14/2021
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Provider Practice Location Address
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Address Line | 7321 S SOUTH SHORE DR APT 11B
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City | CHICAGO
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State | IL
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Zip | 60649-3579
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Country | US
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Telephone | 312-451-4897
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Fax |
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Provider Business Mailing Address
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Address Line | 3231 S HALSTED ST # 227
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City | CHICAGO
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State | IL
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Zip | 60608-6613
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Country | US
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Telephone | 708-634-6709
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Fax |
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Authorized Official
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Title or Position | OWNER AND PSYCHOTHERAPIST
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Name | MS. CYNTHIA CHAMBERS
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Credential | LCPC
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Telephone | 708-634-6709
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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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