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General NPI Number Information
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NPI Number | 1861172991
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Entity Type | Organization
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Legal Business Name | GRACE COUNSELING SERVICES
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Dates
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Enumeration Date | 07/24/2023
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Last Update Date | 07/24/2023
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Provider Practice Location Address
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Address Line | 21471 ULYSSES ST. NE
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City | EAST BETHEL
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State | MN
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Zip | 55011
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Country | US
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Telephone | 763-413-8838
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Fax | 763-413-8878
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Provider Business Mailing Address
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Address Line | 21471 ULYSSES ST. NE
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City | EAST BETHEL
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State | MN
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Zip | 55011
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Country | US
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Telephone | 763-413-8838
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Fax | 763-413-8878
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Authorized Official
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Title or Position | OWNER & DIRECTOR
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Name | MRS. PENNY MAIN-BENNETT
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Credential | LADC
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Telephone | 763-413-8838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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