Provider Demographics
NPI:1659645067
Name:SPIRITSPACE, INC.
Entity Type:Organization
Organization Name:SPIRITSPACE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDOR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC
Authorized Official - Phone:409-765-6093
Mailing Address - Street 1:2228 MECHANIC ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-1592
Mailing Address - Country:US
Mailing Address - Phone:409-765-6093
Mailing Address - Fax:409-765-6093
Practice Address - Street 1:305 MOODY AVE
Practice Address - Street 2:SUITE 243
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-1696
Practice Address - Country:US
Practice Address - Phone:409-765-6093
Practice Address - Fax:409-765-6093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-02
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14440101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty