Provider Demographics
NPI:1194433250
Name:CONNECTED SPACE COUNSELING, LLC
Entity type:Organization
Organization Name:CONNECTED SPACE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:LEANNE
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:503-444-1190
Mailing Address - Street 1:1201 SE 223RD AVE STE 165
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-2577
Mailing Address - Country:US
Mailing Address - Phone:971-404-4668
Mailing Address - Fax:971-273-2708
Practice Address - Street 1:1201 SE 223RD AVE STE 165
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-2577
Practice Address - Country:US
Practice Address - Phone:971-404-4668
Practice Address - Fax:971-273-2708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-08
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional