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NPI Code Detail

MEDICARE: GRACE PATRICK

MEDICARE: GRACE PATRICK
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
1103TC0700XClinical PsychologistPT101NV

General Provider Information

NPI Number : 1598693426
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE PATRICK
Provider Business Mailing Address
First Line : 4505 S MARYLAND PKWY
Second Line : BOX 453033
City : LAS VEGAS
State : NV
Zip : 89154-3033
Country : US
Telephone Number : 650-274-6722
Fax Number :
Provider Business Practice Location Address
First Line : 4505 S MARYLAND PKWY
Second Line : BOX 453033
City : LAS VEGAS
State : NV
Zip : 89154-3033
Country : US
Telephone Number : 650-274-6722
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2026
Last Update Date : 05/11/2026

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Directions to “ GRACE PATRICK ” Practice Location

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