1417328477 NPI number — GRACE COUNSELING, INC

Table of content: (NPI 1417328477)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417328477 NPI number — GRACE COUNSELING, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRACE COUNSELING, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GRACE COUNSELING OF CHESTERFIELD
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417328477
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
34474 23 MILE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESTERFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48047-2003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-996-2273
Provider Business Mailing Address Fax Number:
586-725-6477

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34474 23 MILE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESTERFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48047-2003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-996-2273
Provider Business Practice Location Address Fax Number:
586-725-6477
Provider Enumeration Date:
10/15/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SEBREE
Authorized Official First Name:
GAIL
Authorized Official Middle Name:
SUZANNE
Authorized Official Title or Position:
DIRECTOR / COUNSELOR
Authorized Official Telephone Number:
586-996-2273

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  6401011835 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com