Provider Demographics
NPI:1306355870
Name:GRACIOUS MELODY LLC
Entity Type:Organization
Organization Name:GRACIOUS MELODY LLC
Other - Org Name:GRACIOUS MELODY MUSIC THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MUSIC THERAPIST-BOARD CERTIFIED
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANA CAROLINA
Authorized Official - Middle Name:Q
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MT-BC
Authorized Official - Phone:972-816-5219
Mailing Address - Street 1:3499 RANCH ROAD 620 S APT 8206
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-7069
Mailing Address - Country:US
Mailing Address - Phone:972-816-5219
Mailing Address - Fax:
Practice Address - Street 1:3499 RANCH ROAD 620 S APT 8206
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-7069
Practice Address - Country:US
Practice Address - Phone:972-816-5219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12307225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Single Specialty