MEDICARE: GRACE BEHAVIORAL HEALTH SOLUTIONS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	MD199987	LA

General Provider Information

NPI Number	:	1558662338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE BEHAVIORAL HEALTH SOLUTIONS

Provider Business Mailing Address
First Line	:	2924 KNIGHT ST
Second Line	:	SUITE 414
City	:	SHREVEPORT
State	:	LA
Zip	:	71105-2415
Country	:	US
Telephone Number	:	318-861-7340
Fax Number	:	318-861-7390

Provider Business Practice Location Address
First Line	:	2924 KNIGHT ST
Second Line	:	SUITE 414
City	:	SHREVEPORT
State	:	LA
Zip	:	71105-2415
Country	:	US
Telephone Number	:	318-861-7340
Fax Number	:	318-861-7390

Authorized Official
Title or Position	:	PSYCHIATRIST
Name	:	DR. KIMBERLY DAWN LAW
Credential	:	M.D., M.P.H.
Telephone Number	:	318-453-4084

Provider Enumeration Date	:	11/09/2010
Last Update Date	:	09/05/2017

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