Provider Demographics
NPI:1497082119
Name:GRACE PSYCHOLOGY & COUNSELING
Entity Type:Organization
Organization Name:GRACE PSYCHOLOGY & COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:
Authorized Official - Last Name:SUDDUTH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:281-384-7398
Mailing Address - Street 1:26203 OAK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1960
Mailing Address - Country:US
Mailing Address - Phone:281-384-7398
Mailing Address - Fax:
Practice Address - Street 1:26203 OAK RIDGE DR
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-1960
Practice Address - Country:US
Practice Address - Phone:281-384-7398
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty