| The Therapy Space, Llc | |
|
Rr 3 81766 Pahoa HI 96778 | |
| (808) 481-7283 | |
| Not Available |
| Full Name | The Therapy Space, Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | Rr 3 81766, Pahoa, Hawaii |
| Authorized Official Name and Position | Taliesin Sumner-longboy (OWNER) |
| Authorized Official Contact | 8084817283 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Therapy Space, Llc Rr 3 Box 81766 Pahoa HI 96778 Ph: () - | The Therapy Space, Llc Rr 3 81766 Pahoa HI 96778 Ph: (808) 481-7283 |
| NPI Number | 1679329486 |
|---|---|
| Provider Enumeration Date | 04/24/2024 |
| Last Update Date | 05/22/2024 |
| Certification Date | 05/22/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679329486 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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