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General NPI Number Information
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NPI Number | 1619857349
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Entity Type | Organization
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Legal Business Name | GRACE SPACE SERVICES PLLC
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Dates
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Enumeration Date | 09/04/2025
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 5900 BALCONES DR
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City | AUSTIN
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State | TX
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Zip | 78731-4257
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Country | US
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Telephone | 713-424-9886
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Fax |
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Provider Business Mailing Address
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Address Line | 14668 PERTHSHIRE RD APT A
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City | HOUSTON
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State | TX
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Zip | 77079-7627
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Country | US
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Telephone | 330-612-1868
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ERICA MARIE GRACE JOHNSON
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Credential | LMFT
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Telephone | 330-612-1868
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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