MEDICARE: GRACE NWAIWU AMFT

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	LMFT137156	CA

General Provider Information

NPI Number	:	1366141038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE NWAIWU AMFT

Provider Business Mailing Address
First Line	:	PO BOX 6910
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90504-0110
Country	:	US
Telephone Number	:	310-972-1821
Fax Number	:

Provider Business Practice Location Address
First Line	:	2908 OREGON COURT
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90503
Country	:	US
Telephone Number	:	424-396-5139
Fax Number	:

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

Provider Enumeration Date	:	03/01/2023
Last Update Date	:	05/31/2026

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