Provider Demographics
NPI:1821710955
Name:GRACE THERAPEUTICS OF ARKANSAS
Entity Type:Organization
Organization Name:GRACE THERAPEUTICS OF ARKANSAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLEVELON
Authorized Official - Middle Name:
Authorized Official - Last Name:LASKER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:870-623-6299
Mailing Address - Street 1:1912 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-2729
Mailing Address - Country:US
Mailing Address - Phone:870-623-6299
Mailing Address - Fax:
Practice Address - Street 1:1912 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-2729
Practice Address - Country:US
Practice Address - Phone:870-623-6299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty