Provider Demographics
NPI:1144071986
Name:HEAD SPACE THERAPY CENTER
Entity type:Organization
Organization Name:HEAD SPACE THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:256-501-1115
Mailing Address - Street 1:43 CASTLE DOWN DR SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-1293
Mailing Address - Country:US
Mailing Address - Phone:256-426-4173
Mailing Address - Fax:
Practice Address - Street 1:110 LILY FLAGG RD SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802
Practice Address - Country:US
Practice Address - Phone:256-501-1115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEAD SPACE THERAPY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-29
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty