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General NPI Number Information
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NPI Number | 1679806830
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Entity Type | Organization
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Legal Business Name | GRACE COUNSELING CENTER
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Dates
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Enumeration Date | 09/04/2009
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Last Update Date | 09/04/2009
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Provider Practice Location Address
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Address Line | 2700 1ST ST N #209
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City | SAINT CLOUD
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State | MN
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Zip | 56303-4256
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Country | US
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Telephone | 320-202-9107
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Fax |
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Provider Business Mailing Address
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Address Line | 2700 1ST ST N #209
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City | SAINT CLOUD
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State | MN
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Zip | 56303-4256
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Country | US
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Telephone | 320-202-9107
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BARBARA GAY BACKES
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Credential | LPC, P.A., M.S.
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Telephone | 320-202-9107
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC00366
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License Number State | MN
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