Provider Demographics
NPI:1295564748
Name:GRIT AND GRACE RECOVERY, LLC
Entity type:Organization
Organization Name:GRIT AND GRACE RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:E
Authorized Official - Last Name:BEALL-GOMES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:203-449-7908
Mailing Address - Street 1:169 TURRILL BROOK DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-1045
Mailing Address - Country:US
Mailing Address - Phone:203-449-7908
Mailing Address - Fax:
Practice Address - Street 1:755 MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-2830
Practice Address - Country:US
Practice Address - Phone:203-449-7908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty