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NPI Code Detail

MEDICARE: GRACE COUNSELING GROUP

MEDICARE: GRACE COUNSELING GROUP
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
1106H00000XMarriage & Family TherapistMFC35972CA

General Provider Information

NPI Number : 1245411461
Entity Type Code : Organization
Provider Name (Legal Business Name) : GRACE COUNSELING GROUP
Provider Business Mailing Address
First Line : 4132 KATELLA AVE STE 104
Second Line :
City : LOS ALAMITOS
State : CA
Zip : 90720-3493
Country : US
Telephone Number : 562-598-5991
Fax Number : 562-598-5997
Provider Business Practice Location Address
First Line : 4132 KATELLA AVE STE 104
Second Line :
City : LOS ALAMITOS
State : CA
Zip : 90720-3493
Country : US
Telephone Number : 562-598-5991
Fax Number : 562-598-5997
Authorized Official
Title or Position : CLINIC DIRECTOR
Name : DR. STEVEN CRAIG SCHOGER
Credential : PSY.D.
Telephone Number : 562-598-5991
Provider Enumeration Date : 11/15/2007
Last Update Date : 11/15/2007

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