Provider Demographics
NPI:1760976088
Name:GRACE, CINDI SUE (MS, PLPC)
Entity Type:Individual
Prefix:MS
First Name:CINDI
Middle Name:SUE
Last Name:GRACE
Suffix:
Gender:F
Credentials:MS, PLPC
Other - Prefix:MISS
Other - First Name:CINDI
Other - Middle Name:SUE
Other - Last Name:SCHEERER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:818 MISTY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:MO
Mailing Address - Zip Code:65712-9800
Mailing Address - Country:US
Mailing Address - Phone:417-366-4271
Mailing Address - Fax:
Practice Address - Street 1:1401 S ELLIOTT AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:MO
Practice Address - Zip Code:65605-2103
Practice Address - Country:US
Practice Address - Phone:417-671-9856
Practice Address - Fax:417-671-9881
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018013662261QM0801X, 261QM0850X, 261QM0855X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health