Provider Demographics
NPI:1376258764
Name:BY GRACE COUNSELING AND CONSULTING SERVICES
Entity Type:Organization
Organization Name:BY GRACE COUNSELING AND CONSULTING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEATRIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:FAVELA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:575-202-2376
Mailing Address - Street 1:25620 COUNTY ROAD 65
Mailing Address - Street 2:
Mailing Address - City:LOXLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36551-7622
Mailing Address - Country:US
Mailing Address - Phone:575-202-2376
Mailing Address - Fax:
Practice Address - Street 1:150 W SECTION AVE STE 101
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-3570
Practice Address - Country:US
Practice Address - Phone:575-202-2375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-19
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMC-09438OtherLICENSE