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General NPI Number Information
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NPI Number | 1942731773
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Entity Type | Organization
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Legal Business Name | GRACE PSYCHOLOGICAL HEALTH SERVICES, PLLC
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Dates
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Enumeration Date | 03/23/2017
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Last Update Date | 03/23/2017
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Provider Practice Location Address
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Address Line | 901 W BARDIN RD STE 102
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City | ARLINGTON
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State | TX
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Zip | 76017-6000
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Country | US
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Telephone | 817-501-7362
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Fax | 888-627-2461
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Provider Business Mailing Address
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Address Line | PO BOX 151262
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City | ARLINGTON
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State | TX
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Zip | 76015-7262
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Country | US
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Telephone | 817-501-7362
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Fax | 888-627-2461
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Authorized Official
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Title or Position | OWNER/CLINICAL PSYCHOLOGIST, LPC
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Name | DR. LARONDA STARLING
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Credential | PHD
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Telephone | 817-501-7362
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 67564
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 36475
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License Number State | TX
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