Provider Demographics
NPI:1386411353
Name:THE THERAPY SPACE
Entity type:Organization
Organization Name:THE THERAPY SPACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:507-456-6606
Mailing Address - Street 1:1304 1ST AVENUE CIR NE
Mailing Address - Street 2:
Mailing Address - City:KASSON
Mailing Address - State:MN
Mailing Address - Zip Code:55944-1609
Mailing Address - Country:US
Mailing Address - Phone:507-456-6606
Mailing Address - Fax:
Practice Address - Street 1:2746 SUPERIOR DR NW STE 270
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-8343
Practice Address - Country:US
Practice Address - Phone:507-456-6606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty