| Head Space Therapy Center | |
|
110 Lily Flagg Rd Se Huntsville AL 35802 | |
| (256) 501-1115 | |
| Not Available |
| Full Name | Head Space Therapy Center |
|---|---|
| Speciality | Psychologist |
| Location | 110 Lily Flagg Rd Se, Huntsville, Alabama |
| Authorized Official Name and Position | Judy Carol Park (PSYCHOLOGIST) |
| Authorized Official Contact | 2565011115 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Head Space Therapy Center 43 Castle Down Dr Se Huntsville AL 35802-1293 Ph: (256) 426-4173 | Head Space Therapy Center 110 Lily Flagg Rd Se Huntsville AL 35802 Ph: (256) 501-1115 |
| NPI Number | 1144071986 |
|---|---|
| Provider Enumeration Date | 03/29/2024 |
| Last Update Date | 08/15/2024 |
| Certification Date | 08/14/2024 |
| Medicare PECOS PAC ID | 8426596040 |
|---|---|
| Medicare Enrollment ID | O20240814002596 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144071986 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Judy C Park |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1497896567 PECOS PAC ID: 5193904589 Enrollment ID: I20110201000758 |
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