Provider Demographics
NPI:1588405393
Name:GRACE MINDCARE PC
Entity type:Organization
Organization Name:GRACE MINDCARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:NAKYUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:310-780-8527
Mailing Address - Street 1:9311 SE 36TH ST STE 120
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-3741
Mailing Address - Country:US
Mailing Address - Phone:206-312-5373
Mailing Address - Fax:206-791-3968
Practice Address - Street 1:9311 SE 36TH ST STE 120
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-3741
Practice Address - Country:US
Practice Address - Phone:206-312-5373
Practice Address - Fax:206-791-3968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-05
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health