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General NPI Number Information
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NPI Number | 1861287807
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Entity Type | Organization
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Legal Business Name | GRACEFUL CHANGE COUNSELING SERVICES
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Dates
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Enumeration Date | 04/10/2025
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 5049 EDWARDS RANCH RD FL 4
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City | FORT WORTH
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State | TX
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Zip | 76109-4213
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Country | US
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Telephone | 562-270-5259
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Fax |
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Provider Business Mailing Address
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Address Line | 509 KELLEY CT
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City | FORT WORTH
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State | TX
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Zip | 76120-1701
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Country | US
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Telephone | 805-415-7368
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KALISHA CRONE
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Credential |
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Telephone | 562-270-5259
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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 |
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License Number State |
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