Provider Demographics
NPI:1669278875
Name:OPEN SPACE THERAPY, PLLC
Entity type:Organization
Organization Name:OPEN SPACE THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JARRED
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FITCH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:872-248-4188
Mailing Address - Street 1:4044 N LINCOLN AVE STE 364
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3038
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2280 HICKS ROAD SUITE 508
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008
Practice Address - Country:US
Practice Address - Phone:872-248-4188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health