MEDICARE: THERAPEUTIC ESCAPE SPACE PLLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1609739317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERAPEUTIC ESCAPE SPACE PLLC

Provider Business Mailing Address
First Line	:	18924 KUYKENDAHL RD STE B
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-5585
Country	:	US
Telephone Number	:	346-525-4981
Fax Number	:

Provider Business Practice Location Address
First Line	:	18924 KUYKENDAHL RD STE B
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-5585
Country	:	US
Telephone Number	:	346-525-4981
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	MS. MARTICA LAVETTE SHERMAN
Credential	:	LPC
Telephone Number	:	346-525-4981

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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