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General NPI Number Information
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NPI Number | 1578947594
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Entity Type | Organization
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Legal Business Name | GRACE COUNSELING GROUP
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Dates
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Enumeration Date | 07/20/2015
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Last Update Date | 07/20/2015
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Provider Practice Location Address
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Address Line | 4132 KATELLA AVE SUITE 104
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-3426
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Country | US
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Telephone | 562-598-5991
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Fax | 562-598-5997
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Provider Business Mailing Address
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Address Line | 4132 KATELLA AVE SUITE 104
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-3426
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Country | US
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Telephone | 562-598-5991
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Fax | 562-598-5997
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. KEITH ATTARDO
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Credential | L.M.F.T.
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Telephone | 562-598-5991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | IMF63894
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License Number State | CA
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