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NPI Code Detail

MEDICARE: GRACEFUL GROWTH COUNSELING SERVICES

MEDICARE: GRACEFUL GROWTH COUNSELING SERVICES
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
11041C0700XClinical Social Worker
2101YM0800XMental Health Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1891355376
Entity Type Code : Organization
Provider Name (Legal Business Name) : GRACEFUL GROWTH COUNSELING SERVICES
Provider Business Mailing Address
First Line : 171 N ABERDEEN ST STE 400
Second Line :
City : CHICAGO
State : IL
Zip : 60607-1670
Country : US
Telephone Number : 773-459-1237
Fax Number :
Provider Business Practice Location Address
First Line : 171 N ABERDEEN ST STE 400
Second Line :
City : CHICAGO
State : IL
Zip : 60607-1670
Country : US
Telephone Number : 773-459-1237
Fax Number :
Authorized Official
Title or Position : CLINICAL DIRECTOR
Name : MS. TIFFANY MARIE STEVENS
Credential : LCPC
Telephone Number : 773-459-1237
Provider Enumeration Date : 06/18/2019
Last Update Date : 09/05/2024

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