Provider Demographics
NPI:1033503768
Name:THE HEALING SPACE COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:THE HEALING SPACE COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:BANDOW
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:515-423-2333
Mailing Address - Street 1:3810 1/2 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-3610
Mailing Address - Country:US
Mailing Address - Phone:515-423-2333
Mailing Address - Fax:
Practice Address - Street 1:3810 1/2 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-3610
Practice Address - Country:US
Practice Address - Phone:515-423-2333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06533101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty