Provider Demographics
NPI:1083131585
Name:SUFFICIENT GRACE COUNSELING GROUP LLC
Entity Type:Organization
Organization Name:SUFFICIENT GRACE COUNSELING GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:702-853-7053
Mailing Address - Street 1:5135 CAMINO AL NORTE STE 256
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-2419
Mailing Address - Country:US
Mailing Address - Phone:702-853-7053
Mailing Address - Fax:
Practice Address - Street 1:5135 CAMINO AL NORTE STE 256
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-2419
Practice Address - Country:US
Practice Address - Phone:702-853-7053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health