Provider Demographics
NPI:1639986383
Name:HOPE & GRACE COUNSELING LLC
Entity type:Organization
Organization Name:HOPE & GRACE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:R
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-639-9067
Mailing Address - Street 1:713 CARPENTER RD
Mailing Address - Street 2:
Mailing Address - City:NOCONA
Mailing Address - State:TX
Mailing Address - Zip Code:76255-6820
Mailing Address - Country:US
Mailing Address - Phone:918-639-9067
Mailing Address - Fax:
Practice Address - Street 1:13701 N DIAMOND LAKE RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:MN
Practice Address - Zip Code:55327-9583
Practice Address - Country:US
Practice Address - Phone:918-639-9067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty