Healthcare Provider Details

I. General information

NPI: 1437414471
Provider Name (Legal Business Name): GRACE M MORAN MA, LMHC, CVRS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9218 MIGUE CIR
PT CHARLOTTE FL
33981-3119
US

IV. Provider business mailing address

9218 MIGUE CIR
PT CHARLOTTE FL
33981-3119
US

V. Phone/Fax

Practice location:
  • Phone: 941-451-7396
  • Fax: 941-343-2913
Mailing address:
  • Phone: 941-451-7396
  • Fax: 941-343-2913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: