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General NPI Number Information
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NPI Number | 1750104220
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Entity Type | Organization
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Legal Business Name | GRACE INTEGRATED, LLC
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Dates
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Enumeration Date | 11/04/2024
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 125 WINDSOR DR STE 113
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City | OAK BROOK
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State | IL
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Zip | 60523-4082
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Country | US
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Telephone | 708-512-5555
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Fax | 708-688-1023
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Provider Business Mailing Address
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Address Line | 414 PLAZA DR STE 301
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City | WESTMONT
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State | IL
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Zip | 60559-5508
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Country | US
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Telephone | 708-512-5555
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JULIE MARIE MCDEVITT
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Credential | LCPC
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Telephone | 630-313-9741
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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