Provider Demographics
NPI:1538943451
Name:GRACE AUTISM & NEURODIVERSITY CENTER
Entity type:Organization
Organization Name:GRACE AUTISM & NEURODIVERSITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GRACIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES-MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:346-351-6123
Mailing Address - Street 1:26010 OAK RIDGE DR STE 107
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1972
Mailing Address - Country:US
Mailing Address - Phone:346-351-6123
Mailing Address - Fax:346-380-2162
Practice Address - Street 1:26010 OAK RIDGE DR STE 107
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-1972
Practice Address - Country:US
Practice Address - Phone:346-351-6123
Practice Address - Fax:346-380-2162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty