Provider Demographics
NPI:1578947594
Name:GRACE COUNSELING GROUP
Entity Type:Organization
Organization Name:GRACE COUNSELING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:ATTARDO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:562-598-5991
Mailing Address - Street 1:4132 KATELLA AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3426
Mailing Address - Country:US
Mailing Address - Phone:562-598-5991
Mailing Address - Fax:562-598-5997
Practice Address - Street 1:4132 KATELLA AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3426
Practice Address - Country:US
Practice Address - Phone:562-598-5991
Practice Address - Fax:562-598-5997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF63894251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health