Provider Demographics
NPI:1538641089
Name:MORNING, GRACE
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:MORNING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13322 I ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-1111
Mailing Address - Country:US
Mailing Address - Phone:402-230-5861
Mailing Address - Fax:531-200-5808
Practice Address - Street 1:12811 Q ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-3211
Practice Address - Country:US
Practice Address - Phone:402-230-5861
Practice Address - Fax:531-200-5808
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-31
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18-70995106S00000X
106S00000X
NE1-22-62493103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician