Provider Demographics
NPI:1508127846
Name:GRACE TO GROW
Entity Type:Organization
Organization Name:GRACE TO GROW
Other - Org Name:GRACE TO CHANGE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC
Authorized Official - Phone:972-542-2900
Mailing Address - Street 1:1216 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070
Mailing Address - Country:US
Mailing Address - Phone:972-542-2900
Mailing Address - Fax:972-542-2007
Practice Address - Street 1:1216 N CENTRAL EXPY
Practice Address - Street 2:SUITE 104
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070
Practice Address - Country:US
Practice Address - Phone:972-542-2900
Practice Address - Fax:972-542-2007
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRACE TO GROW
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-04
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3531-3532251S00000X, 261QR0405X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251S00000XAgenciesCommunity/Behavioral Health