MEDICARE: THE HEALING SPACE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1043800923
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE HEALING SPACE, LLC

Provider Business Mailing Address
First Line	:	2055 CRAIGSHIRE RD STE 420A
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-4036
Country	:	US
Telephone Number	:	314-485-8991
Fax Number	:

Provider Business Practice Location Address
First Line	:	2055 CRAIGSHIRE RD STE 420A
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-4036
Country	:	US
Telephone Number	:	314-485-8991
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. ARYN BOSTIC
Credential	:	LPC, CD-PICD
Telephone Number	:	314-485-8991

Provider Enumeration Date	:	01/24/2021
Last Update Date	:	03/05/2021

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Directions to “THE HEALING SPACE, LLC ” Practice Location

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