Healthcare Provider Details

I. General information

NPI: 1578269957
Provider Name (Legal Business Name): GRACEFUL WARRIOR COUNSELING AND CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 E STATE ST
BRADY NE
69123-3043
US

IV. Provider business mailing address

PO BOX 115
BRADY NE
69123-0115
US

V. Phone/Fax

Practice location:
  • Phone: 402-917-0334
  • Fax:
Mailing address:
  • Phone: 402-917-0334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER SPENCER
Title or Position: OWNER
Credential:
Phone: 402-917-0334