Provider Demographics
NPI:1972346526
Name:GRACA, CALLIE (MA, LPCC)
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:
Last Name:GRACA
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3260 47TH ST APT 109
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-5424
Mailing Address - Country:US
Mailing Address - Phone:320-249-3406
Mailing Address - Fax:
Practice Address - Street 1:225 W SOUTH BOULDER RD STE 103
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-1194
Practice Address - Country:US
Practice Address - Phone:720-868-9641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health