Provider Demographics
NPI:1023694478
Name:A PLACE FOR GRACE
Entity type:Organization
Organization Name:A PLACE FOR GRACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:LYNE
Authorized Official - Last Name:BROTHERTON
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP, LMHC
Authorized Official - Phone:515-620-3284
Mailing Address - Street 1:37053 HUTCHINGS AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:IA
Mailing Address - Zip Code:51540-4067
Mailing Address - Country:US
Mailing Address - Phone:712-621-7300
Mailing Address - Fax:
Practice Address - Street 1:11 S 1ST ST
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4315
Practice Address - Country:US
Practice Address - Phone:515-620-3284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty