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General NPI Number Information
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NPI Number | 1841995073
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Entity Type | Organization
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Legal Business Name | CO-CREATED SPACES: THERAPY, SUPERVISION, AND CONSULTATION, PLLC
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Dates
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Enumeration Date | 04/05/2023
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Last Update Date | 04/05/2023
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Provider Practice Location Address
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Address Line | 3707 GRAUSTARK ST APT 4
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City | HOUSTON
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State | TX
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Zip | 77006-4243
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Country | US
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Telephone | 713-364-3340
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Fax |
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Provider Business Mailing Address
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Address Line | 12918 COOPERS HAWK DR
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City | HOUSTON
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State | TX
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Zip | 77044-4400
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Country | US
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Telephone | 713-364-3340
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Fax |
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Authorized Official
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Title or Position | MANAGER CLINICIAN
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Name | ADRIANA E. GIL-WILKERSON
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Credential | PH.D., LMFT SUPERVIS
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Telephone | 713-364-3340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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