=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942167465
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRACE WELLNESS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2026
-----------------------------------------------------
Last Update Date | 01/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10920 W LINCOLN AVE UNIT D
-----------------------------------------------------
City | WEST ALLIS
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53227-1130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-320-2281
-----------------------------------------------------
Fax | 414-310-1726
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10920 W LINCOLN AVE UNIT D
-----------------------------------------------------
City | WEST ALLIS
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53227-1130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-320-2281
-----------------------------------------------------
Fax | 414-310-1726
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO, PMHNP
-----------------------------------------------------
Name | DR. KRISTY RENAE BAARS
-----------------------------------------------------
Credential | APNP, PMHNP-BC, APSW
-----------------------------------------------------
Telephone | 502-320-2281
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------