MEDICARE: GRACE FOR LIFE COUNSELING AND CONSULTING ASSOCIATES

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	200860	TX

General Provider Information

NPI Number	:	1871853036
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE FOR LIFE COUNSELING AND CONSULTING ASSOCIATES

Provider Business Mailing Address
First Line	:	8930 FOURWINDS DR
Second Line	:	SUITE 200
City	:	WINDCREST
State	:	TX
Zip	:	78239-1970
Country	:	US
Telephone Number	:	210-778-8256
Fax Number	:

Provider Business Practice Location Address
First Line	:	8930 FOURWINDS DR
Second Line	:	SUITE 200
City	:	WINDCREST
State	:	TX
Zip	:	78239-1970
Country	:	US
Telephone Number	:	210-778-8256
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST/OWNER
Name	:	DR. BELINDA RICHARDSON
Credential	:	LMFT
Telephone Number	:	210-778-8256

Provider Enumeration Date	:	05/22/2012
Last Update Date	:	05/22/2012

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