| A Space For Healing, Llc | |
|
8500 Station St Ste 300j Mentor OH 44060-4963 | |
| (440) 721-8979 | |
| Not Available |
| Full Name | A Space For Healing, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 8500 Station St Ste 300j, Mentor, Ohio |
| Authorized Official Name and Position | Christine Anne Vavro (TRAUMA THERAPIST) |
| Authorized Official Contact | 4404134637 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| A Space For Healing, Llc 8500 Station Street Ste 300j Mentor OH 44060-5756 Ph: (407) 218-9794 | A Space For Healing, Llc 8500 Station St Ste 300j Mentor OH 44060-4963 Ph: (440) 721-8979 |
| NPI Number | 1669013934 |
|---|---|
| Provider Enumeration Date | 10/08/2019 |
| Last Update Date | 02/05/2024 |
| Certification Date | 02/05/2024 |
| Medicare PECOS PAC ID | 1951732379 |
|---|---|
| Medicare Enrollment ID | O20200518003206 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669013934 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Eric J Main |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689770265 PECOS PAC ID: 3577527167 Enrollment ID: I20110429000601 |
| Provider Name | Christine Vavro |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114432978 PECOS PAC ID: 5193052041 Enrollment ID: I20190814004051 |
| Provider Name | Cara Kless |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1477066470 PECOS PAC ID: 4789027863 Enrollment ID: I20240206000703 |
| Provider Name | Sarah Vivian Jeppesen |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1699258764 PECOS PAC ID: 9739522822 Enrollment ID: I20240206000864 |
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