Provider Demographics
NPI:1285232058
Name:CREATING SPACE THERAPY, PLLC
Entity Type:Organization
Organization Name:CREATING SPACE THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:630-601-3459
Mailing Address - Street 1:34 N ISLAND AVE STE F
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-1996
Mailing Address - Country:US
Mailing Address - Phone:630-601-3460
Mailing Address - Fax:331-422-2912
Practice Address - Street 1:34 N ISLAND AVE STE F
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-1996
Practice Address - Country:US
Practice Address - Phone:630-601-3460
Practice Address - Fax:331-422-2912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-14
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty