1679931547 NPI number — AMAZING GRACE COUNSELING SERVICES

Table of content: VICTORIA EUGENIA HERRERA ATR (NPI 1164166997)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679931547 NPI number — AMAZING GRACE COUNSELING SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMAZING GRACE COUNSELING SERVICES
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:
6
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:
1679931547
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8132 TUMBLEWEED TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76108-3519
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
682-554-5802
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 UNIVERSITY DR
Provider Second Line Business Practice Location Address:
112
Provider Business Practice Location Address City Name:
FT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76107-2168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
682-702-1453
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/05/2016

Additional Information

Authorized Official

Authorized Official Last Name:
DOWNEY
Authorized Official First Name:
LAURIE
Authorized Official Middle Name:
BREWER
Authorized Official Title or Position:
THERAPIST, COUNSELOR
Authorized Official Telephone Number:
682-702-1453

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  72379 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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