Provider Demographics
NPI:1790458479
Name:GRACE MENTAL HEALTH SERVICES PLLC
Entity Type:Organization
Organization Name:GRACE MENTAL HEALTH SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER/ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:NDUMBE
Authorized Official - Suffix:
Authorized Official - Credentials:PHMNP
Authorized Official - Phone:800-789-3543
Mailing Address - Street 1:15784 W DESERT MIRAGE DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-4639
Mailing Address - Country:US
Mailing Address - Phone:800-789-3543
Mailing Address - Fax:928-496-2133
Practice Address - Street 1:2350 W HIGHWAY 89A # 1023
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-5344
Practice Address - Country:US
Practice Address - Phone:800-789-3543
Practice Address - Fax:928-496-2133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-28
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty