| Lavender Space, Inc | |
|
100 E San Antonio St Ste 101 San Marcos TX 78666-5568 | |
| (512) 831-6696 | |
| Not Available |
| Full Name | Lavender Space, Inc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 100 E San Antonio St Ste 101, San Marcos, Texas |
| Authorized Official Name and Position | Aryn Thompson (OWNER/PSYCHOTHERAPIST) |
| Authorized Official Contact | 5128316696 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lavender Space, Inc 100 E San Antonio St Ste 101 San Marcos TX 78666-5568 Ph: (512) 831-6696 | Lavender Space, Inc 100 E San Antonio St Ste 101 San Marcos TX 78666-5568 Ph: (512) 831-6696 |
| NPI Number | 1932923752 |
|---|---|
| Provider Enumeration Date | 11/08/2024 |
| Last Update Date | 11/08/2024 |
| Certification Date | 11/08/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932923752 | NPI | - | NPPES |
| 1174179212 | Other | TX | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
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