Provider Demographics
NPI:1285405472
Name:A ZEN SPACE, PLLC
Entity type:Organization
Organization Name:A ZEN SPACE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPCC, NCC
Authorized Official - Phone:740-357-8667
Mailing Address - Street 1:800 13TH ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-2638
Mailing Address - Country:US
Mailing Address - Phone:740-357-8667
Mailing Address - Fax:
Practice Address - Street 1:800 13TH ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2638
Practice Address - Country:US
Practice Address - Phone:740-357-8667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY273906698Medicaid