Healthcare Provider Details

I. General information

NPI: 1306750435
Provider Name (Legal Business Name): GRACEFUL HAVEN BEHAVIORAL HEALTH AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 S PRESTON RD STE 510
PROSPER TX
75078-1907
US

IV. Provider business mailing address

291 S PRESTON RD STE 510
PROSPER TX
75078-1907
US

V. Phone/Fax

Practice location:
  • Phone: 469-701-1034
  • Fax:
Mailing address:
  • Phone: 469-701-1034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL

VIII. Authorized Official

Name: GERTRUDE NWOKORIE
Title or Position: ADMINISTRATOR
Credential:
Phone: 469-701-1034