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General NPI Number Information
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NPI Number | 1609704840
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Entity Type | Organization
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Legal Business Name | GRACE MEDICAL & WELLNESS CLINIC, LLC
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Dates
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Enumeration Date | 05/09/2026
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Last Update Date | 05/09/2026
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Provider Practice Location Address
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Address Line | 1104 W 1ST ST STE 3
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City | LAUREL
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State | MS
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Zip | 39440-4357
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Country | US
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Telephone | 334-580-0851
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Fax |
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Provider Business Mailing Address
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Address Line | 1104 W 1ST ST STE 3
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City | LAUREL
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State | MS
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Zip | 39440-4357
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Country | US
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Telephone | 334-580-0851
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TINA NAYLOR
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Credential |
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Telephone | 334-580-0851
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health 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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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