Provider Demographics
NPI:1902422116
Name:GRACE COUNSELING, LLC
Entity Type:Organization
Organization Name:GRACE COUNSELING, LLC
Other - Org Name:SPEARFISH COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, CSW-PIP
Authorized Official - Phone:605-644-7511
Mailing Address - Street 1:1320 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-1525
Mailing Address - Country:US
Mailing Address - Phone:605-644-7494
Mailing Address - Fax:605-644-7356
Practice Address - Street 1:1320 NORTH AVE
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-1525
Practice Address - Country:US
Practice Address - Phone:605-644-7494
Practice Address - Fax:605-644-7356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-23
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1023070844Medicaid