Healthcare Provider Details

I. General information

NPI: 1811733074
Provider Name (Legal Business Name): THE GRACE SPACE, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2024
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 LAMY LN STE I
MONROE LA
71201-9200
US

IV. Provider business mailing address

1900 LAMY LN STE I
MONROE LA
71201-9200
US

V. Phone/Fax

Practice location:
  • Phone: 318-593-1593
  • Fax: 318-593-1900
Mailing address:
  • Phone: 318-593-1593
  • Fax: 318-593-1900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. DENITRA BEASLEY
Title or Position: OWNER
Credential: LPC
Phone: 318-593-1593