MEDICARE: THE HEALING 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1780411777
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE HEALING SPACE PLLC

Provider Business Mailing Address
First Line	:	25329 S 227TH ST
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-2161
Country	:	US
Telephone Number	:	480-617-3912
Fax Number	:

Provider Business Practice Location Address
First Line	:	25329 S 227TH ST
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-2161
Country	:	US
Telephone Number	:	775-224-4629
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	BRITTANY JO LARSON
Credential	:	LCSW
Telephone Number	:	480-617-3912

Provider Enumeration Date	:	09/16/2024
Last Update Date	:	09/08/2025

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Directions to “THE HEALING SPACE PLLC ” Practice Location

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