Healthcare Provider Details

I. General information

NPI: 1497664064
Provider Name (Legal Business Name): MOUNTAIN OF GRACE COUNSELING GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 LOREX RD
MINDEN LA
71055-5817
US

IV. Provider business mailing address

155 LOREX RD
MINDEN LA
71055-5817
US

V. Phone/Fax

Practice location:
  • Phone: 757-770-8214
  • Fax:
Mailing address:
  • Phone: 757-770-8214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANTHONY BLALOCK
Title or Position: OWNER
Credential:
Phone: 757-770-8214