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General NPI Number Information
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NPI Number | 1750142675
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Entity Type | Organization
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Legal Business Name | HEALING GRACE COUNSELING CENTER CORP
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Dates
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Enumeration Date | 01/18/2024
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Last Update Date | 01/19/2024
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Provider Practice Location Address
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Address Line | 259 S EUCLID AVE
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City | PASADENA
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State | CA
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Zip | 91101-2717
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Country | US
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Telephone | 909-536-0570
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Fax |
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Provider Business Mailing Address
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Address Line | 931 E WALNUT ST UNIT 201
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City | PASADENA
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State | CA
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Zip | 91106-5520
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Country | US
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Telephone | 909-536-0570
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | DR. YOUNGOK KIM
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Credential |
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Telephone | 909-536-0570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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