Provider Demographics
NPI:1588307961
Name:GRACE THERAPY & HEALING PLLC
Entity type:Organization
Organization Name:GRACE THERAPY & HEALING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BRADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-900-5108
Mailing Address - Street 1:1675 N FREEDOM BLVD STE 10B
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-6906
Mailing Address - Country:US
Mailing Address - Phone:801-900-6056
Mailing Address - Fax:
Practice Address - Street 1:1675 N FREEDOM BLVD STE 10B
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-6906
Practice Address - Country:US
Practice Address - Phone:801-900-6056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty