MEDICARE: LIMINAL SPACE PSYCHOTHERAPY 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1750231270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIMINAL SPACE PSYCHOTHERAPY PLLC

Provider Business Mailing Address
First Line	:	13 LEDGEWOOD CT
Second Line	:
City	:	MIDDLEBURY
State	:	VT
Zip	:	05753-1159
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13 LEDGEWOOD CT
Second Line	:
City	:	MIDDLEBURY
State	:	VT
Zip	:	05753-1159
Country	:	US
Telephone Number	:	414-640-6049
Fax Number	:

Authorized Official
Title or Position	:	MENTAL HEALTH COUNSELOR
Name	:	KATIE L GILLESPIE
Credential	:	LCMHC
Telephone Number	:	414-640-6049

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	02/03/2026

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