Provider Demographics
NPI:1710770128
Name:FAITHGRACEJOY, PLLC
Entity type:Organization
Organization Name:FAITHGRACEJOY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC
Authorized Official - Phone:817-821-9882
Mailing Address - Street 1:112 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:COMANCHE
Mailing Address - State:TX
Mailing Address - Zip Code:76442-3215
Mailing Address - Country:US
Mailing Address - Phone:817-821-9882
Mailing Address - Fax:
Practice Address - Street 1:112 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:COMANCHE
Practice Address - State:TX
Practice Address - Zip Code:76442-3215
Practice Address - Country:US
Practice Address - Phone:817-821-9882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)