Provider Demographics
NPI:1497498802
Name:MEANDERING GRACE
Entity Type:Organization
Organization Name:MEANDERING GRACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:QUICK
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:937-408-0004
Mailing Address - Street 1:117 W MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-3799
Mailing Address - Country:US
Mailing Address - Phone:740-571-4218
Mailing Address - Fax:740-652-1463
Practice Address - Street 1:117 W MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3799
Practice Address - Country:US
Practice Address - Phone:740-571-4218
Practice Address - Fax:740-652-1463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-14
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0215824Medicaid