Provider Demographics
NPI:1679315535
Name:HEALING SPACE COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:HEALING SPACE COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:GALVAN
Authorized Official - Suffix:
Authorized Official - Credentials:CMRS
Authorized Official - Phone:832-528-6481
Mailing Address - Street 1:4963 N MULLIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2962
Mailing Address - Country:US
Mailing Address - Phone:312-451-1110
Mailing Address - Fax:
Practice Address - Street 1:4963 N MULLIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2962
Practice Address - Country:US
Practice Address - Phone:312-451-1110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty