Provider Demographics
NPI:1932766839
Name:WILLOW BRITT, GRACE JENAE (MA,NBCC,LAC-A)
Entity Type:Individual
Prefix:MS
First Name:GRACE
Middle Name:JENAE
Last Name:WILLOW BRITT
Suffix:
Gender:F
Credentials:MA,NBCC,LAC-A
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:GALE
Other - Last Name:BRITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT,CPC
Mailing Address - Street 1:5506 LEDESMA RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78721
Mailing Address - Country:US
Mailing Address - Phone:505-316-1815
Mailing Address - Fax:
Practice Address - Street 1:1205 W. 43RD ST.
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756
Practice Address - Country:US
Practice Address - Phone:512-710-7645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-26
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR7329101YP2500X
NCA17308101YP2500X
OR24685225700000X
TX88134101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist