Healthcare Provider Details

I. General information

NPI: 1255086252
Provider Name (Legal Business Name): GRACE ANDERTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2022
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2229 NW 32ND ST # 1/2
OKLAHOMA CITY OK
73112-7921
US

IV. Provider business mailing address

2229 NW 32ND ST
OKLAHOMA CITY OK
73112-7921
US

V. Phone/Fax

Practice location:
  • Phone: 405-456-9531
  • Fax:
Mailing address:
  • Phone: 405-456-9531
  • 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:
Title or Position:
Credential:
Phone: