MEDICARE: GRACE SPACE THERAPY SPOT 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	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417899733
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE SPACE THERAPY SPOT PLLC

Provider Business Mailing Address
First Line	:	5900 BALCONES DR # 30952
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-4257
Country	:	US
Telephone Number	:	210-686-3594
Fax Number	:

Provider Business Practice Location Address
First Line	:	5900 BALCONES DR # 30952
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-4257
Country	:	US
Telephone Number	:	210-686-3594
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST/OWNER
Name	:	ASTRID TRUSS
Credential	:	LPC
Telephone Number	:	325-518-1049

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

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