Provider Demographics
NPI:1932687332
Name:GRACEFUL THERAPY, PLLC
Entity Type:Organization
Organization Name:GRACEFUL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:FISH
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:630-733-9108
Mailing Address - Street 1:113 MAIN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-8593
Mailing Address - Country:US
Mailing Address - Phone:630-733-9108
Mailing Address - Fax:630-912-4242
Practice Address - Street 1:113 MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-8593
Practice Address - Country:US
Practice Address - Phone:630-733-9108
Practice Address - Fax:630-912-4242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 106H00000X
IL166.001164106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty