1568919983 NPI number — GRACE COUNSELING & PSYCHOTHERAPY INC.

Table of content: (NPI 1568919983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568919983 NPI number — GRACE COUNSELING & PSYCHOTHERAPY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRACE COUNSELING & PSYCHOTHERAPY 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:
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:
1568919983
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5700 BALTIMORE DR
Provider Second Line Business Mailing Address:
UNIT 161
Provider Business Mailing Address City Name:
LA MESA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91942-1616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-405-4980
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
135 E 3RD AVE STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ESCONDIDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92025-4252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-381-8472
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2016

Additional Information

Authorized Official

Authorized Official Last Name:
GRACE
Authorized Official First Name:
MONIKA
Authorized Official Middle Name:
MARIA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
619-381-8472

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY24462 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PSY24462 . This is a "LICENSE" identifier . This identifiers is of the category "OTHER".




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