Provider Demographics
NPI:1790503779
Name:THE SPACE BETWEEN, LLC
Entity type:Organization
Organization Name:THE SPACE BETWEEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:GATZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT-T
Authorized Official - Phone:316-212-8414
Mailing Address - Street 1:1215 SE 60TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-9355
Mailing Address - Country:US
Mailing Address - Phone:316-212-8414
Mailing Address - Fax:
Practice Address - Street 1:622 E DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-3504
Practice Address - Country:US
Practice Address - Phone:316-282-3444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty