Provider Demographics
NPI:1033696265
Name:SELF SPACE, PLLC
Entity Type:Organization
Organization Name:SELF SPACE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:LUND
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:206-799-0712
Mailing Address - Street 1:10245 36TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98146-1111
Mailing Address - Country:US
Mailing Address - Phone:206-799-0712
Mailing Address - Fax:
Practice Address - Street 1:7220 WOODLAWN AVE NE # 306
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-5336
Practice Address - Country:US
Practice Address - Phone:206-799-0712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty