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General NPI Number Information
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NPI Number | 1710770128
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Entity Type | Organization
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Legal Business Name | FAITHGRACEJOY, PLLC
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Dates
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Enumeration Date | 05/28/2025
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 112 W CENTRAL AVE
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City | COMANCHE
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State | TX
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Zip | 76442-3215
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Country | US
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Telephone | 817-821-9882
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Fax |
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Provider Business Mailing Address
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Address Line | 112 W CENTRAL AVE
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City | COMANCHE
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State | TX
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Zip | 76442-3215
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Country | US
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Telephone | 817-821-9882
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Fax |
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Authorized Official
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Title or Position | DIRECT OWNER
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Name | MRS. LISA MARIE DAVIS
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Credential | MED, LPC
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Telephone | 817-821-9882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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