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General NPI Number Information
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NPI Number | 1417518523
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Entity Type | Organization
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Legal Business Name | DANIEL GRACE COUNSELING AND SUPERVISION, PLLC
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Dates
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Enumeration Date | 06/28/2019
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Last Update Date | 06/28/2019
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Provider Practice Location Address
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Address Line | 1219 COMMERCE DR STE 3
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City | MOUNTAIN HOME
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State | AR
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Zip | 72653-2604
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Country | US
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Telephone | 870-926-6280
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Fax |
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Provider Business Mailing Address
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Address Line | 1645 COUNTY ROAD 625
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City | MOUNTAIN HOME
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State | AR
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Zip | 72653-6185
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Country | US
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Telephone | 870-926-6280
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Fax |
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Authorized Official
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Title or Position | OWNER/PRACTIONER
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Name | DANIEL RAY GRACE
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Credential | LPC
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Telephone | 870-926-6280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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