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NPI Code Detail

MEDICARE: GRACE THERAPY AND WELLNESS, PLLC

MEDICARE: GRACE THERAPY AND WELLNESS, 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
1101YM0800XMental Health Counselor
2133N00000XNutritionist
3133V00000XRegistered Dietitian
41041C0700XClinical Social Worker

General Provider Information

NPI Number : 1710563994
Entity Type Code : Organization
Provider Name (Legal Business Name) : GRACE THERAPY AND WELLNESS, PLLC
Provider Business Mailing Address
First Line : 805 W 10TH ST STE 302
Second Line :
City : AUSTIN
State : TX
Zip : 78701-2038
Country : US
Telephone Number : 404-895-7405
Fax Number :
Provider Business Practice Location Address
First Line : 805 W 10TH ST STE 302
Second Line :
City : AUSTIN
State : TX
Zip : 78701-2038
Country : US
Telephone Number : 404-895-7405
Fax Number :
Authorized Official
Title or Position : OWNER
Name : GRACE DOWD
Credential : LCSW-S
Telephone Number : 404-895-7405
Provider Enumeration Date : 03/19/2021
Last Update Date : 03/22/2021

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1033781356 — GRACE LAWTON LICSW, LCSW
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Directions to “GRACE THERAPY AND WELLNESS, PLLC ” Practice Location

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