Provider Demographics
NPI:1730800426
Name:GRATEFUL GUIDANCE RECOVERY LLC
Entity type:Organization
Organization Name:GRATEFUL GUIDANCE RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GISELE
Authorized Official - Middle Name:
Authorized Official - Last Name:NZEUKOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-256-7835
Mailing Address - Street 1:1735 N 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-6527
Mailing Address - Country:US
Mailing Address - Phone:520-256-7835
Mailing Address - Fax:
Practice Address - Street 1:1735 N 11TH AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-6527
Practice Address - Country:US
Practice Address - Phone:520-256-7835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty