Provider Demographics
NPI:1225639958
Name:GRACE ABOUNDS
Entity Type:Organization
Organization Name:GRACE ABOUNDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRACE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:870-232-4181
Mailing Address - Street 1:975 COLEY DR UNIT 1232
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72654-7115
Mailing Address - Country:US
Mailing Address - Phone:870-232-4181
Mailing Address - Fax:
Practice Address - Street 1:1219 COMMERCE DR STE 3
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2604
Practice Address - Country:US
Practice Address - Phone:870-232-4181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)