Provider Demographics
NPI:1821051491
Name:PENA, GRACE (PSYD, LMHC)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:
Last Name:PENA
Suffix:
Gender:F
Credentials:PSYD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 BRIMMING LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MINNEOLA
Mailing Address - State:FL
Mailing Address - Zip Code:34715-6000
Mailing Address - Country:US
Mailing Address - Phone:407-209-7492
Mailing Address - Fax:352-241-8372
Practice Address - Street 1:600 U.S. HWY 27 SUITE # 1
Practice Address - Street 2:
Practice Address - City:MINNEOLA
Practice Address - State:FL
Practice Address - Zip Code:34715-6000
Practice Address - Country:US
Practice Address - Phone:407-209-7492
Practice Address - Fax:352-241-8372
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 5773101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health