Healthcare Provider Details

I. General information

NPI: 1750104220
Provider Name (Legal Business Name): GRACE INTEGRATED, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 WINDSOR DR STE 113
OAK BROOK IL
60523-4082
US

IV. Provider business mailing address

414 PLAZA DR STE 301
WESTMONT IL
60559-5508
US

V. Phone/Fax

Practice location:
  • Phone: 708-512-5555
  • Fax: 708-688-1023
Mailing address:
  • Phone: 708-512-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JULIE MARIE MCDEVITT
Title or Position: OWNER
Credential: LCPC
Phone: 630-313-9741