Provider Demographics
NPI:1952632903
Name:GRACE PERSPECTIVES COUNSELING OF GRAPEVINE, LLC
Entity type:Organization
Organization Name:GRACE PERSPECTIVES COUNSELING OF GRAPEVINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUTHERFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MA, NCC, LPC
Authorized Official - Phone:214-704-2318
Mailing Address - Street 1:920 S MAIN ST
Mailing Address - Street 2:SUITE 198
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-7516
Mailing Address - Country:US
Mailing Address - Phone:817-416-9364
Mailing Address - Fax:817-416-9364
Practice Address - Street 1:920 S MAIN ST
Practice Address - Street 2:SUITE 198
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-7516
Practice Address - Country:US
Practice Address - Phone:817-416-9364
Practice Address - Fax:817-416-9364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-14
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61494101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty