Provider Demographics
NPI:1255072872
Name:YOUR SPACE COUNSELING FOR MARRIAGE AND FAMILIES INC.
Entity type:Organization
Organization Name:YOUR SPACE COUNSELING FOR MARRIAGE AND FAMILIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAVER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:916-233-6604
Mailing Address - Street 1:701 HIGH ST STE 205
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-4734
Mailing Address - Country:US
Mailing Address - Phone:916-233-6604
Mailing Address - Fax:530-466-3329
Practice Address - Street 1:701 HIGH ST STE 205
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-4734
Practice Address - Country:US
Practice Address - Phone:916-233-6604
Practice Address - Fax:530-466-3329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty