Provider Demographics
NPI:1578120382
Name:SACRED SPACE COUNSELING LLC
Entity Type:Organization
Organization Name:SACRED SPACE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORZOV
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-419-6226
Mailing Address - Street 1:PO BOX 285
Mailing Address - Street 2:
Mailing Address - City:SISTERS
Mailing Address - State:OR
Mailing Address - Zip Code:97759-0285
Mailing Address - Country:US
Mailing Address - Phone:541-419-6226
Mailing Address - Fax:
Practice Address - Street 1:750 BUCKAROO TRL
Practice Address - Street 2:
Practice Address - City:SISTERS
Practice Address - State:OR
Practice Address - Zip Code:97759-9427
Practice Address - Country:US
Practice Address - Phone:541-419-6226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-28
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty