Healthcare Provider Details

I. General information

NPI: 1750142675
Provider Name (Legal Business Name): HEALING GRACE COUNSELING CENTER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2024
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 S EUCLID AVE
PASADENA CA
91101-2717
US

IV. Provider business mailing address

931 E WALNUT ST UNIT 201
PASADENA CA
91106-5520
US

V. Phone/Fax

Practice location:
  • Phone: 909-536-0570
  • Fax:
Mailing address:
  • Phone: 909-536-0570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. YOUNGOK KIM
Title or Position: FOUNDER
Credential:
Phone: 909-536-0570