Provider Demographics
NPI:1669040556
Name:SAFEPACES MENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:SAFEPACES MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL PSYCHOTHERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:MARSEILLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC
Authorized Official - Phone:571-282-8023
Mailing Address - Street 1:10808 ROYAL GLEN DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-4578
Mailing Address - Country:US
Mailing Address - Phone:571-282-8023
Mailing Address - Fax:
Practice Address - Street 1:10808 ROYAL GLEN DR
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-4578
Practice Address - Country:US
Practice Address - Phone:571-282-8023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAFEPACES MENTAL HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)