MEDICARE: GRACE BEHAVIORAL HEALTH AND WELLNESS PLLC

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1356189088
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE BEHAVIORAL HEALTH AND WELLNESS PLLC

Provider Business Mailing Address
First Line	:	2910 MONTGOMERY CIR
Second Line	:
City	:	COMMERCE TOWNSHIP
State	:	MI
Zip	:	48390-3605
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2910 MONTGOMERY CIR
Second Line	:
City	:	COMMERCE TOWNSHIP
State	:	MI
Zip	:	48390-3605
Country	:	US
Telephone Number	:	810-620-6927
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KELLEY MCCHESTER
Credential	:
Telephone Number	:	810-620-6927

Provider Enumeration Date	:	07/17/2024
Last Update Date	:	07/17/2024

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