Provider Demographics
NPI:1225889074
Name:MARKED FOR GRACE COUNSELING CENTER
Entity type:Organization
Organization Name:MARKED FOR GRACE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-S
Authorized Official - Phone:469-867-2301
Mailing Address - Street 1:4209 W WACO DR STE 4
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-7111
Mailing Address - Country:US
Mailing Address - Phone:469-669-2726
Mailing Address - Fax:
Practice Address - Street 1:4209 W WACO DR STE 4
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-7111
Practice Address - Country:US
Practice Address - Phone:469-669-2726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-29
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty