Provider Demographics
NPI:1255169926
Name:HOLDING SPACE RECOVERY PROJECT
Entity type:Organization
Organization Name:HOLDING SPACE RECOVERY PROJECT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CARISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:931-241-3312
Mailing Address - Street 1:825 N HIGHWAY 31
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:IN
Mailing Address - Zip Code:47102-1830
Mailing Address - Country:US
Mailing Address - Phone:812-722-5731
Mailing Address - Fax:
Practice Address - Street 1:825 N HIGHWAY 31
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:IN
Practice Address - Zip Code:47102-1830
Practice Address - Country:US
Practice Address - Phone:812-722-5731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-24
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)