Provider Demographics
NPI:1124611231
Name:HEALING GRACE THERAPY SERVICES, LLC
Entity type:Organization
Organization Name:HEALING GRACE THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GIOVANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSITANO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:575-680-1376
Mailing Address - Street 1:PO BOX 13
Mailing Address - Street 2:
Mailing Address - City:DONA ANA
Mailing Address - State:NM
Mailing Address - Zip Code:88032-0013
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2801 MISSOURI AVE STE 8
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-5061
Practice Address - Country:US
Practice Address - Phone:575-680-1376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty