Healthcare Provider Details

I. General information

NPI: 1871492777
Provider Name (Legal Business Name): GRACEFULLY YOU COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2026
Last Update Date: 11/05/2026
Certification Date: 11/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11722 MOONSAIL DR
PARRISH FL
34219-1860
US

IV. Provider business mailing address

11722 MOONSAIL DR
PARRISH FL
34219-1860
US

V. Phone/Fax

Practice location:
  • Phone: 941-292-8224
  • Fax:
Mailing address:
  • Phone: 941-292-8224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CRISTINA YOLANDA JARA RIVERA
Title or Position: OWNER
Credential: LMHC
Phone: 941-292-8224