Provider Demographics
NPI:1275157224
Name:HOLDING SPACE THERAPY, LLC
Entity Type:Organization
Organization Name:HOLDING SPACE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUTKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT, RPT
Authorized Official - Phone:651-564-8456
Mailing Address - Street 1:N2440 ARA GLEN DR STE 203
Mailing Address - Street 2:
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-3736
Mailing Address - Country:US
Mailing Address - Phone:651-564-8456
Mailing Address - Fax:
Practice Address - Street 1:N2440 ARA GLEN DR STE 203
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-3736
Practice Address - Country:US
Practice Address - Phone:651-564-8456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-05
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)