Provider Demographics
NPI:1487528964
Name:A MINDFUL SPACE THERAPY AND COACHING, PLLC
Entity type:Organization
Organization Name:A MINDFUL SPACE THERAPY AND COACHING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBIO MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:815-324-2750
Mailing Address - Street 1:1476 N 3039TH RD
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-9032
Mailing Address - Country:US
Mailing Address - Phone:815-324-2750
Mailing Address - Fax:
Practice Address - Street 1:1476 N 3039TH RD
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-9032
Practice Address - Country:US
Practice Address - Phone:815-324-2750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-30
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty