MEDICARE: GRACE BEHAVIORAL HEALTH

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1760194419
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	4275 NW 1ST COURT RD
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34475-8762
Country	:	US
Telephone Number	:	352-777-9235
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 NE 25TH AVE STE 104
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34470-5665
Country	:	US
Telephone Number	:	352-541-5500
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	ZENIA HARRIS
Credential	:	LCSW
Telephone Number	:	352-541-5500

Provider Enumeration Date	:	12/14/2022
Last Update Date	:	12/14/2022

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Directions to “GRACE BEHAVIORAL HEALTH ” Practice Location

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