Provider Demographics
NPI:1063094134
Name:GRATEFUL HEART COUNSELING LLC
Entity type:Organization
Organization Name:GRATEFUL HEART COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:
Authorized Official - First Name:JESSIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BROCKMEIER
Authorized Official - Suffix:
Authorized Official - Credentials:MED, NCC, LPC
Authorized Official - Phone:314-972-3579
Mailing Address - Street 1:406 N SEMINOLE
Mailing Address - Street 2:
Mailing Address - City:CLEVER
Mailing Address - State:MO
Mailing Address - Zip Code:65631-6745
Mailing Address - Country:US
Mailing Address - Phone:314-972-3579
Mailing Address - Fax:
Practice Address - Street 1:283 US HIGHWAY 60 W
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:MO
Practice Address - Zip Code:65738-1432
Practice Address - Country:US
Practice Address - Phone:417-248-1748
Practice Address - Fax:417-200-2686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health