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General NPI Number Information
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NPI Number | 1942002100
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Entity Type | Organization
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Legal Business Name | A PLACE OF GRACE PSYCHIATRY PLLC
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Dates
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Enumeration Date | 03/26/2025
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 8565 S EASTERN AVE
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City | LAS VEGAS
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State | NV
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Zip | 89123-2808
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Country | US
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Telephone | 702-848-5888
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Fax |
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Provider Business Mailing Address
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Address Line | 111 S GIBSON RD APT 3304
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City | HENDERSON
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State | NV
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Zip | 89012-2670
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Country | US
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Telephone | 845-820-7685
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Fax |
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Authorized Official
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Title or Position | PMHNP
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Name | GRACEANN PITTARI
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Credential | PMHNP
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Telephone | 702-848-5888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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