Provider Demographics
NPI:1629872221
Name:HEADSPACE
Entity type:Organization
Organization Name:HEADSPACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NETWORK OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHTEMLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-212-7507
Mailing Address - Street 1:PO BOX 31001-4089
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91110-4089
Mailing Address - Country:US
Mailing Address - Phone:919-815-4637
Mailing Address - Fax:
Practice Address - Street 1:2417 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-4009
Practice Address - Country:US
Practice Address - Phone:855-446-4374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-02
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health