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Active NPI 1427860022 Organization (Entity Type 2)

Black Space Llc

Counselor - Mental Health • Bothell, WA

About Black Space Llc NPI 1427860022 Summary

Black Space Llc is a verified healthcare organization specializing in Counselor - Mental Health operating in Bothell, WA. Located at 22722 29TH DRIVE SOUTHEAST SUITE 100, this facility provides patient care and medical services under National Provider Identifier (NPI) 1427860022.

Administrative operations and authorized compliance are overseen by Tamera Gittens (Lmhc).

Facility Location & Contact Primary Location

Facility Address

22722 29th Drive Southeast Suite 100

Bothell, WA 98021

Telephone 9294457277

Authorized Official Information

Authorized Contact Name

Tamera Gittens

Title / Role

Lmhc

Official Telephone

9294457277

Facility Classifications & Specialties

Counselor - Mental Health Primary Taxonomy

NUCC Taxonomy Code: 101YM0800X

Definition to come...

Facility & Registry History Timeline

Chronological log of verified NPI organization updates, branch relocations, and registry updates

6 Historical Events

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NPI Profile Active January 22, 2025

NPI status registered as active in NPPES database

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Updated Practice Location January 22, 2025

Registered at 22722 29TH DRIVE SOUTHEAST SUITE 100, BOTHELL, WA 98021 (Tel: 9294457277)

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Updated Business Mailing Address January 22, 2025

Registered at 300 LENORA ST # 1348, SEATTLE, WA 981212411 (Tel: 9294457277)

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Organization / Clinic Name Updated January 22, 2025

Operating as BLACK SPACE LLC

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Medical Taxonomy / Specialty Registered (Primary Specialty) January 22, 2025

Counselor

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Initial NPI Registration & Enumeration January 22, 2025

First registered as active Healthcare Organization in NPPES Database.

Patient & Community Reviews

Verified patient ratings, healthcare experiences, and facility photos

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NPI Organization Metadata

NPI Number: 1427860022

Entity Type:

Organization Organization (Hospital, Clinic, Group Practice) (Type 2 NPI)

Enumeration Date: January 22, 2025

Last Update: January 22, 2025

Update or Correct Listing

Mailing Address

300 Lenora St # 1348

Seattle, WA 981212411

Phone: 9294457277

Public Domain Record This organization profile is sourced from public domain datasets published by CMS and NPPES under FOIA.

⚠️ Medical Disclaimer

Facility details are provided for public information only. In case of a medical emergency, call 911 immediately.