=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679378111
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRACE FAMILY AND RELATIONSHIP THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2025
-----------------------------------------------------
Last Update Date | 02/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1112 FOREST RIDGE LOOP PEARL RIVER
-----------------------------------------------------
City | LOUISIANA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70452-3731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-345-9728
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1112 FOREST RIDGE LOOP
-----------------------------------------------------
City | PEARL RIVER
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70452-3731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-583-8222
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | MS. ANGELA TONEY
-----------------------------------------------------
Credential | DR., PSY. D.LPCT
-----------------------------------------------------
Telephone | 504-583-5822
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------