Provider Demographics
NPI:1770003956
Name:TSOKA, GRACE
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:TSOKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4167 CRESCENT DR STE 201
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-3643
Mailing Address - Country:US
Mailing Address - Phone:314-243-0324
Mailing Address - Fax:
Practice Address - Street 1:4167 CRESCENT DR STE 201
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-3643
Practice Address - Country:US
Practice Address - Phone:314-243-0324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO19155101YP1600X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral