Healthcare Provider Details

I. General information

NPI: 1205640190
Provider Name (Legal Business Name): FRONTIER BEHAVIORAL CONSULT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 MORRIS AVE STE 102
SPRINGFIELD NJ
07081-1421
US

IV. Provider business mailing address

99 MORRIS AVE STE 102
SPRINGFIELD NJ
07081-1421
US

V. Phone/Fax

Practice location:
  • Phone: 732-250-9284
  • Fax:
Mailing address:
  • Phone: 732-250-9284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GRACE NWOKIKE
Title or Position: PMHNP
Credential:
Phone: 732-250-9284