Provider Demographics
NPI:1477384733
Name:HEADSPACEWELLNESS CENTER
Entity type:Organization
Organization Name:HEADSPACEWELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:OPARA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:313-585-8148
Mailing Address - Street 1:8919 RINGNECK DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1059
Mailing Address - Country:US
Mailing Address - Phone:313-585-8148
Mailing Address - Fax:
Practice Address - Street 1:8919 RINGNECK DR
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1059
Practice Address - Country:US
Practice Address - Phone:313-585-8148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty