Provider Demographics
NPI:1497437016
Name:ESSENTIAL GRACE MENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:ESSENTIAL GRACE MENTAL HEALTH SERVICES
Other - Org Name:ESSENTIAL GRACE MENTAL HEALTH SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-988-0060
Mailing Address - Street 1:618 MOHEGAN CIR
Mailing Address - Street 2:
Mailing Address - City:CANTONMENT
Mailing Address - State:FL
Mailing Address - Zip Code:32533-5634
Mailing Address - Country:US
Mailing Address - Phone:850-619-1276
Mailing Address - Fax:
Practice Address - Street 1:1300 N PALAFOX ST STE 102D
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-2678
Practice Address - Country:US
Practice Address - Phone:850-988-0060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-03
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty