MEDICARE: AMAZING GRACE COUNSELING SERVICES

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	251S00000X	Community/Behavioral Health Agency	72379	TX

General Provider Information

NPI Number	:	1679931547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMAZING GRACE COUNSELING SERVICES

Provider Business Mailing Address
First Line	:	8132 TUMBLEWEED TRL
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76108-3519
Country	:	US
Telephone Number	:	682-554-5802
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 UNIVERSITY DR
Second Line	:	112
City	:	FT WORTH
State	:	TX
Zip	:	76107-2168
Country	:	US
Telephone Number	:	682-702-1453
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST, COUNSELOR
Name	:	DR. LAURIE BREWER DOWNEY
Credential	:	PHD,
Telephone Number	:	682-702-1453

Provider Enumeration Date	:	02/05/2016
Last Update Date	:	02/05/2016

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Directions to “AMAZING GRACE COUNSELING SERVICES ” Practice Location

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