Provider Demographics
NPI:1023369642
Name:ABUNDANT GRACE COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:ABUNDANT GRACE COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANALISA
Authorized Official - Middle Name:NIETO
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC CANDIDATE
Authorized Official - Phone:918-269-9511
Mailing Address - Street 1:2448 E 81ST ST STE 5125
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-4213
Mailing Address - Country:US
Mailing Address - Phone:918-392-7875
Mailing Address - Fax:800-260-7966
Practice Address - Street 1:2448 E 81ST ST STE 5125
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-4213
Practice Address - Country:US
Practice Address - Phone:918-392-7875
Practice Address - Fax:800-260-7966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty