Healthcare Provider Details

I. General information

NPI: 1912553421
Provider Name (Legal Business Name): KAREN MICHELE GRACE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4304 S BEARFIELD RD
COLUMBIA MO
65201-9557
US

IV. Provider business mailing address

347 SHADY ROCK LN
O FALLON MO
63368-7470
US

V. Phone/Fax

Practice location:
  • Phone: 573-874-8686
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2016016613
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: