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General NPI Number Information
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NPI Number | 1235660853
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Entity Type | Organization
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Legal Business Name | GRACE COUNSELING AND CONSULTING SERVICES, LLC
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Dates
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Enumeration Date | 03/24/2017
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Last Update Date | 03/24/2017
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Provider Practice Location Address
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Address Line | 138 KENT HAVEN DR
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City | SOMERSET
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State | KY
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Zip | 42503-6281
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Country | US
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Telephone | 606-637-3538
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Fax |
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Provider Business Mailing Address
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Address Line | 138 KENT HAVEN DR
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City | SOMERSET
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State | KY
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Zip | 42503-6281
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Country | US
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Telephone | 606-637-3538
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. DUSTIN PHELPS
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Credential | M.S.
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Telephone | 606-637-3538
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | KY-0085
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License Number State | KY
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