Provider Demographics
NPI:1558662338
Name:GRACE BEHAVIORAL HEALTH SOLUTIONS
Entity Type:Organization
Organization Name:GRACE BEHAVIORAL HEALTH SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:LAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:318-453-4084
Mailing Address - Street 1:2924 KNIGHT ST
Mailing Address - Street 2:SUITE 414
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-2415
Mailing Address - Country:US
Mailing Address - Phone:318-861-7340
Mailing Address - Fax:318-861-7390
Practice Address - Street 1:2924 KNIGHT ST
Practice Address - Street 2:SUITE 414
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-2415
Practice Address - Country:US
Practice Address - Phone:318-861-7340
Practice Address - Fax:318-861-7390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-09
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD1999872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty