Provider Demographics
NPI:1437414471
Name:MORAN, GRACE M (MA, LMHC, CVRS)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:M
Last Name:MORAN
Suffix:
Gender:F
Credentials:MA, LMHC, CVRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:OSPREY
Mailing Address - State:FL
Mailing Address - Zip Code:34229-9668
Mailing Address - Country:US
Mailing Address - Phone:941-451-7396
Mailing Address - Fax:941-343-2913
Practice Address - Street 1:2111 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:OSPREY
Practice Address - State:FL
Practice Address - Zip Code:34229-9668
Practice Address - Country:US
Practice Address - Phone:941-451-7396
Practice Address - Fax:941-343-2913
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor