| Grace Therapy, Pc | |
|
19971 Beverly Manor Ln Council Bluffs IA 51503-5497 | |
| (402) 679-2611 | |
| Not Available |
| Full Name | Grace Therapy, Pc |
|---|---|
| Speciality | Social Worker |
| Location | 19971 Beverly Manor Ln, Council Bluffs, Iowa |
| Authorized Official Name and Position | Tonyarae C Bouvier (PRACTICE OWNER) |
| Authorized Official Contact | 4026792611 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grace Therapy, Pc 19971 Beverly Manor Ln Council Bluffs IA 51503-5497 Ph: (402) 679-2611 | Grace Therapy, Pc 19971 Beverly Manor Ln Council Bluffs IA 51503-5497 Ph: (402) 679-2611 |
| NPI Number | 1215504345 |
|---|---|
| Provider Enumeration Date | 06/08/2021 |
| Last Update Date | 06/08/2021 |
| Certification Date | 06/08/2021 |
| Medicare PECOS PAC ID | 5294139416 |
|---|---|
| Medicare Enrollment ID | O20210811000328 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215504345 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Tonyarae C Bouvier |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699018382 PECOS PAC ID: 4385978063 Enrollment ID: I20190701000124 |
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