Provider Demographics
NPI:1740928845
Name:CREATING SPACE THERAPY, LLC
Entity type:Organization
Organization Name:CREATING SPACE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:HALEIGH
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LAC, NCC
Authorized Official - Phone:918-521-7989
Mailing Address - Street 1:8240 NORA LN
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-9693
Mailing Address - Country:US
Mailing Address - Phone:918-521-7989
Mailing Address - Fax:
Practice Address - Street 1:7509 CANTRELL RD STE 205
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-2500
Practice Address - Country:US
Practice Address - Phone:501-396-9308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health