Provider Demographics
NPI:1518732254
Name:SUPPORT SPACE THERAPY AND WELLNESS, PLLC
Entity Type:Organization
Organization Name:SUPPORT SPACE THERAPY AND WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANEK-MONTANEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:203-253-6892
Mailing Address - Street 1:8528 DAVIS BLVD #134
Mailing Address - Street 2:BOX 139
Mailing Address - City:N RICHLND HLS
Mailing Address - State:TX
Mailing Address - Zip Code:76182
Mailing Address - Country:US
Mailing Address - Phone:917-914-3951
Mailing Address - Fax:
Practice Address - Street 1:560 HIDDEN MEADOW DR
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-1228
Practice Address - Country:US
Practice Address - Phone:203-253-6892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)