MEDICARE: GRACE COUNSELING CENTER NFP

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	:	1528853603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE COUNSELING CENTER NFP

Provider Business Mailing Address
First Line	:	5 N PRINCETON AVE
Second Line	:
City	:	VILLA PARK
State	:	IL
Zip	:	60181-2336
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 N PRINCETON AVE
Second Line	:
City	:	VILLA PARK
State	:	IL
Zip	:	60181-2336
Country	:	US
Telephone Number	:	708-252-3290
Fax Number	:

Authorized Official
Title or Position	:	MAIN DIRECTOR
Name	:	HENRY CHU
Credential	:
Telephone Number	:	312-371-7194

Provider Enumeration Date	:	04/10/2025
Last Update Date	:	04/10/2025

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