Healthcare Provider Details

I. General information

NPI: 1699557694
Provider Name (Legal Business Name): GRACE IN HEALINGS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 ALPHA RD STE 80-3
DALLAS TX
75240-4355
US

IV. Provider business mailing address

5301 ALPHA RD STE 80-3
DALLAS TX
75240-4355
US

V. Phone/Fax

Practice location:
  • Phone: 682-215-1691
  • Fax: 682-267-4840
Mailing address:
  • Phone: 682-215-1691
  • Fax: 682-267-4840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: PRAJNAWATI WIBOWO
Title or Position: CEO
Credential:
Phone: 682-215-1691