Healthcare Provider Details

I. General information

NPI: 1154115392
Provider Name (Legal Business Name): GRACIOUS MIND THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2025
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

969 N DOWNING ST APT 501
DENVER CO
80218-4306
US

IV. Provider business mailing address

969 N DOWNING ST APT 501
DENVER CO
80218-4306
US

V. Phone/Fax

Practice location:
  • Phone: 806-367-1997
  • Fax:
Mailing address:
  • Phone: 806-367-1997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GRACE MORGAN
Title or Position: OWNER/THERAPIST
Credential:
Phone: 806-367-1997