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General NPI Number Information
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NPI Number | 1497151484
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Entity Type | Organization
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Legal Business Name | AMAZING GRACE COUNSELING SERVICES, PLLC
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Dates
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Enumeration Date | 11/18/2014
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Last Update Date | 12/01/2016
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Provider Practice Location Address
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Address Line | 9830 APPELLATE WAY
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City | CONVERSE
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State | TX
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Zip | 78109-1985
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Country | US
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Telephone | 210-883-6287
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Fax | 210-305-5750
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Provider Business Mailing Address
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Address Line | 9830 APPELLATE WAY
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City | CONVERSE
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State | TX
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Zip | 78109-1985
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Country | US
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Telephone | 210-883-6287
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Fax | 210-305-5750
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Authorized Official
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Title or Position | CEO
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Name | MS. NECOLE W. FRYAR
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Credential | MA, LPC
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Telephone | 210-883-6287
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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 | 66851
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 66851
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License Number State | TX
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