Provider Demographics
NPI:1407548290
Name:THE RELATIONAL SPACE PSYCHOTHERAPY LLC
Entity Type:Organization
Organization Name:THE RELATIONAL SPACE PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:503-928-0559
Mailing Address - Street 1:8300 NE HIGHWAY 99W
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-8243
Mailing Address - Country:US
Mailing Address - Phone:971-267-2789
Mailing Address - Fax:541-275-0960
Practice Address - Street 1:8300 NE HIGHWAY 99W
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-8243
Practice Address - Country:US
Practice Address - Phone:971-267-2789
Practice Address - Fax:541-275-0960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-22
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty