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General NPI Number Information
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NPI Number | 1871244657
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Entity Type | Organization
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Legal Business Name | GRIT AND GRACE COUNSELING LLC
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Dates
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Enumeration Date | 01/13/2022
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Last Update Date | 01/26/2022
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Provider Practice Location Address
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Address Line | 312 E DUPONT RD STE 101
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City | FORT WAYNE
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State | IN
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Zip | 46825-8000
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Country | US
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Telephone | 260-227-5900
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Fax |
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Provider Business Mailing Address
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Address Line | 1817 BEINEKE RD
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City | FORT WAYNE
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State | IN
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Zip | 46808-1627
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/FOUNDER
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Name | KELSEY TIERNON
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Credential |
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Telephone | 260-227-5900
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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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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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