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General NPI Number Information
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NPI Number | 1639986383
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Entity Type | Organization
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Legal Business Name | HOPE & GRACE COUNSELING LLC
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Dates
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Enumeration Date | 12/16/2024
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 13701 N DIAMOND LAKE RD
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City | DAYTON
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State | MN
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Zip | 55327-9583
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Country | US
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Telephone | 918-639-9067
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Fax |
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Provider Business Mailing Address
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Address Line | 713 CARPENTER RD
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City | NOCONA
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State | TX
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Zip | 76255-6820
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Country | US
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Telephone | 918-639-9067
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANDREA R CLARK
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Credential |
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Telephone | 918-639-9067
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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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