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General NPI Number Information
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NPI Number | 1922731546
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Entity Type | Organization
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Legal Business Name | SAFE SPACE THERAPY, LLC
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Dates
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Enumeration Date | 07/01/2022
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Last Update Date | 05/20/2023
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Provider Practice Location Address
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Address Line | 1551 WINCHESTER DR
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City | WESTLAKE
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State | OH
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Zip | 44145-2113
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Country | US
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Telephone | 216-307-3919
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Fax |
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Provider Business Mailing Address
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Address Line | 1551 WINCHESTER DR
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City | WESTLAKE
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State | OH
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Zip | 44145-2113
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Country | US
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Telephone | 216-307-3919
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SAMANTHA RAE BROWN
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Credential | LPCCS, LCDC III, NCC
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Telephone | 216-307-3919
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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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