Provider Demographics
NPI:1679931547
Name:AMAZING GRACE COUNSELING SERVICES
Entity Type:Organization
Organization Name:AMAZING GRACE COUNSELING SERVICES
Other - Org Name:LAURIE DOWNEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERAPIST, COUNSELOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:BREWER
Authorized Official - Last Name:DOWNEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD,
Authorized Official - Phone:682-702-1453
Mailing Address - Street 1:8132 TUMBLEWEED TRL
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-3519
Mailing Address - Country:US
Mailing Address - Phone:682-554-5802
Mailing Address - Fax:
Practice Address - Street 1:601 UNIVERSITY DR
Practice Address - Street 2:112
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2168
Practice Address - Country:US
Practice Address - Phone:682-702-1453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72379251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========Medicaid