Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Grey Space Therapy, LCSW Professional Corporation

Organization Mental Health Counselor · NPI 1174238190

Grey Space Therapy, LCSW Professional Corporation is a Mental Health Counselor in Riverside, California. Registered with an NPI since 2023.

In the registry since
2023
Specialties on file
4

Practice location Address checks out

5055 Canyon Crest Dr Ste 216
Riverside, CA 92507-6015
Phone: (714) 749-5554
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X
Mental Health Counselor Taxonomy 101YM0800X
Professional Counselor Taxonomy 101YP2500X
Marriage & Family Therapist Taxonomy 106H00000X

Record details

NPI number1174238190
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Fabiola Pacheco — Founder · (714) 749-5554
NPI enumeratedJanuary 16, 2023
Last updated in NPPESJanuary 16, 2023
Certification dateJanuary 14, 2023
Mailing address5744 Crest Ave, Riverside, CA 92503-8634

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