Provider Demographics
NPI:1700593712
Name:COUNSELING WELLNESS SPACE
Entity Type:Organization
Organization Name:COUNSELING WELLNESS SPACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:MARLIN
Authorized Official - Last Name:HAND
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:214-238-5455
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-0369
Mailing Address - Country:US
Mailing Address - Phone:214-238-5455
Mailing Address - Fax:
Practice Address - Street 1:12650 N BEACH ST STE 114-909
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-4243
Practice Address - Country:US
Practice Address - Phone:214-238-5455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty