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General NPI Number Information
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NPI Number | 1699252700
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Entity Type | Organization
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Legal Business Name | GRACE COUNSELING, INC.
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Dates
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Enumeration Date | 07/21/2018
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Last Update Date | 07/21/2018
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Provider Practice Location Address
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Address Line | 110 E 10TH ST STE 2
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City | PELLA
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State | IA
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Zip | 50219-2002
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Country | US
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Telephone | 641-780-4295
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Fax |
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Provider Business Mailing Address
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Address Line | 110 E 10TH ST STE 2
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City | PELLA
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State | IA
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Zip | 50219-2002
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Country | US
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Telephone | 641-780-4295
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | MRS. JANA VINK
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Credential | LISW
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Telephone | 641-780-4295
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 007955
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License Number State | IA
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