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Mental Space Llc
Adolescent and Children Mental Health Clinic/Center in Martinez, Georgia
NPI 1295372225

Mental Space Llc is an Adolescent and Children Mental Health Clinic/Center based in Goodfellow Afb, GA and is specialized in Adolescent and Children Mental Health. Mental Space Llc practices in Martinez, GA. The NPI Number for Mental Space Llc is 1295372225 and holds a License No. (Georgia).

The current practice location address for Mental Space Llc is 4408 Columbia Rd Ste 104, Martinez, GA and can be reached out via phone at 707-819-1390.

Location: 4408 Columbia Rd Ste 104, Martinez, GA, 76908-0163
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1295372225
Provider Name
Mental Space Llc
Credential
Provider Entity Type
Organization
Address
4408 Columbia Rd Ste 104, Martinez, GA, 76908-0163
Phone Number
707-819-1390
Fax Number
Provider Enumeration Date
12/10/2019
Last Update Date
03/13/2024
institution
Provider Business Practice Location Address Details
Address
4408 Columbia Rd Ste 104
City
Martinez
State
Georgia
Zip
30907-4561
Phone Number
707-819-1390
Fax Number
person
Provider Business Mailing Address Details
Address
4408 Columbia Rd Ste 104
City
Martinez
State
Georgia
Zip
30907-4561
Phone Number
707-819-1390
Fax Number
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Mental Health (Including Community Mental Health Center)
Taxonomy
261QM0801X
License No.
()
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Adult Mental Health
Taxonomy
261QM0850X
License No.
()
Definition
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults.
person
Provider's Taxonomy Details 3
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Adolescent and Children Mental Health
Taxonomy
261QM0855X
License No.
()
Definition
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training.
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