Provider Demographics
NPI:1215417480
Name:GRACE BEHAVIORAL SERVICES, LLC
Entity Type:Organization
Organization Name:GRACE BEHAVIORAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-986-9978
Mailing Address - Street 1:20 PRICE LN
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-7417
Mailing Address - Country:US
Mailing Address - Phone:386-986-9978
Mailing Address - Fax:
Practice Address - Street 1:20 PRICE LN
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-7417
Practice Address - Country:US
Practice Address - Phone:386-986-9978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15910101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty