Provider Demographics
NPI:1336803097
Name:SAFE SPACE MENTAL HEALTH LLC
Entity type:Organization
Organization Name:SAFE SPACE MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:708-634-6709
Mailing Address - Street 1:3231 S HALSTED ST # 227
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-6613
Mailing Address - Country:US
Mailing Address - Phone:708-634-6709
Mailing Address - Fax:
Practice Address - Street 1:7321 S SOUTH SHORE DR APT 11B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-3579
Practice Address - Country:US
Practice Address - Phone:312-451-4897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-28
Last Update Date:2021-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty