Provider Demographics
NPI:1407637143
Name:GRACEFUL THERAPY LLC
Entity type:Organization
Organization Name:GRACEFUL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASSAGE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:STEVENS-HAYDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-658-8224
Mailing Address - Street 1:PO BOX 840103
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77284-0103
Mailing Address - Country:US
Mailing Address - Phone:903-658-8224
Mailing Address - Fax:
Practice Address - Street 1:18510 GREEN LAND WAY STE E
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-7927
Practice Address - Country:US
Practice Address - Phone:903-658-8224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-09
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental IllnessGroup - Multi-Specialty