| Graceful Pathways Inc | |
|
11530 Us 49 Suite E Gulfport MS 39503-3950 | |
| (228) 707-2007 | |
| Not Available |
| Full Name | Graceful Pathways Inc |
|---|---|
| Speciality | Social Worker |
| Location | 11530 Us 49, Gulfport, Mississippi |
| Authorized Official Name and Position | Jodi Renee Klubnik (OWNER/DIRECTOR) |
| Authorized Official Contact | 2286694367 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Graceful Pathways Inc 4509 Jefferson Ave Gulfport MS 39507-4022 Ph: (228) 669-4367 | Graceful Pathways Inc 11530 Us 49 Suite E Gulfport MS 39503-3950 Ph: (228) 707-2007 |
| NPI Number | 1912624495 |
|---|---|
| Provider Enumeration Date | 10/25/2022 |
| Last Update Date | 02/13/2023 |
| Certification Date | 02/13/2023 |
| Medicare PECOS PAC ID | 7719356773 |
|---|---|
| Medicare Enrollment ID | O20221213003344 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912624495 | NPI | - | NPPES |
| Provider Name | Jodi R Klubnik |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952776684 PECOS PAC ID: 8628447687 Enrollment ID: I20221213003354 |
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