Healthcare Provider Details

I. General information

NPI: 1043139678
Provider Name (Legal Business Name): GRACE LIFELINE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N WATER ST STE 139
OWOSSO MI
48867-2807
US

IV. Provider business mailing address

215 N WATER ST STE 139
OWOSSO MI
48867-2807
US

V. Phone/Fax

Practice location:
  • Phone: 989-720-4510
  • Fax:
Mailing address:
  • Phone: 989-720-4510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: THERESA BRADEN-HORSTMAN
Title or Position: THERAPIST
Credential: LMSW
Phone: 989-720-4510