Provider Demographics
NPI:1235824582
Name:MY HEALING SPACE COUNSELING PLLC
Entity Type:Organization
Organization Name:MY HEALING SPACE COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED ADDICTION SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:FANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:CAS
Authorized Official - Phone:720-209-8897
Mailing Address - Street 1:1155 S HAVANA ST # 11-1150
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4019
Mailing Address - Country:US
Mailing Address - Phone:720-209-8897
Mailing Address - Fax:
Practice Address - Street 1:19549 RANDOLPH PL
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80249-8609
Practice Address - Country:US
Practice Address - Phone:720-209-8897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-11
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty