| Black Space Llc | |
|
22722 29th Drive Southeast Suite 100 Bothell WA 98021 | |
| (929) 445-7277 | |
| Not Available |
| Full Name | Black Space Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 22722 29th Drive Southeast Suite 100, Bothell, Washington |
| Authorized Official Name and Position | Tamera Gittens (LMHC) |
| Authorized Official Contact | 9294457277 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Black Space Llc 300 Lenora St # 1348 Seattle WA 98121-2411 Ph: (929) 445-7277 | Black Space Llc 22722 29th Drive Southeast Suite 100 Bothell WA 98021 Ph: (929) 445-7277 |
| NPI Number | 1427860022 |
|---|---|
| Provider Enumeration Date | 01/22/2025 |
| Last Update Date | 01/22/2025 |
| Certification Date | 01/06/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427860022 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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