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General NPI Number Information
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NPI Number | 1952632903
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Entity Type | Organization
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Legal Business Name | GRACE PERSPECTIVES COUNSELING OF GRAPEVINE, LLC
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Dates
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Enumeration Date | 01/14/2010
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Last Update Date | 01/27/2010
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Provider Practice Location Address
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Address Line | 920 S MAIN ST SUITE 198
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City | GRAPEVINE
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State | TX
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Zip | 76051-7516
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Country | US
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Telephone | 817-416-9364
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Fax | 817-416-9364
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Provider Business Mailing Address
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Address Line | 920 S MAIN ST SUITE 198
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City | GRAPEVINE
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State | TX
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Zip | 76051-7516
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Country | US
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Telephone | 817-416-9364
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Fax | 817-416-9364
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Authorized Official
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Title or Position | COUNSELOR
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Name | CHERYL J RUTHERFORD
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Credential | MA, NCC, LPC
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Telephone | 214-704-2318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 61494
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 61494
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License Number State | TX
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