Provider Demographics
NPI:1982944336
Name:IACUONE, GRACE ELIZABETH (MED, LPC)
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:ELIZABETH
Last Name:IACUONE
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 COUNTRY WOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-1612
Mailing Address - Country:US
Mailing Address - Phone:214-532-3505
Mailing Address - Fax:
Practice Address - Street 1:4600 LOCKHILL SELMA RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2186
Practice Address - Country:US
Practice Address - Phone:214-532-3505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62105101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor