1679378111 NPI number — GRACE FAMILY AND RELATIONSHIP THERAPY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679378111 NPI number — GRACE FAMILY AND RELATIONSHIP THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRACE FAMILY AND RELATIONSHIP THERAPY
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:
Provider Other Organization Name Type Code:
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:
1679378111
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1112 FOREST RIDGE LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEARL RIVER
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70452-3731
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-583-8222
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1112 FOREST RIDGE LOOP
Provider Second Line Business Practice Location Address:
PEARL RIVER
Provider Business Practice Location Address City Name:
LOUISIANA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70452-3731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-345-9728
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/18/2025

Additional Information

Authorized Official

Authorized Official Last Name:
TONEY
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
504-583-5822

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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