Healthcare Provider Details

I. General information

NPI: 1033096813
Provider Name (Legal Business Name): GRACE MARIE MOLENGRAFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2025
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15455 CONWAY RD
CHESTERFIELD MO
63017-6022
US

IV. Provider business mailing address

7105 N VILLANOVA DR
SAINT LOUIS MO
63123-1617
US

V. Phone/Fax

Practice location:
  • Phone: 636-675-7566
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2026039945
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: