MEDICARE: GRACE RICHARDSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1053990820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE RICHARDSON

Provider Business Mailing Address
First Line	:	3774 BROADWAY
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-2235
Country	:	US
Telephone Number	:	513-272-2800
Fax Number	:

Provider Business Practice Location Address
First Line	:	3774 BROADWAY
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-2235
Country	:	US
Telephone Number	:	513-272-2800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2021
Last Update Date	:	01/15/2026

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Directions to “ GRACE RICHARDSON ” Practice Location

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