NPIMap

Organization Active NPI

Grit and Grace Therapy PLLC

  • Clinical Social Worker
  • Mahomet, IL
National Provider Identifier
1013666015
Registry record updated Mar 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
GRIT AND GRACE THERAPY PLLC
Practice address
1204 E Oak St Ste 2-2
Mahomet, IL 61853-2795
Phone
(217) 530-6708
NPI assigned
Mar 18, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Jessica L McClellan, LCSWNPI 1487209359
Title
Owner
Phone
(217) 530-5608

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

1204 E Oak St Ste 2-2
Mahomet, IL 61853-2795

Mailing address

1204 E Oak St Ste 2-2
Mahomet, IL 61853-2795
Phone (217) 530-6708

Other identifiers 1

IdentifierTypeStateIssuer
1487209359OtherINDIVIDUAL NPI NUMBER

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL gritandgracetherapy@gmail.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221028002667 IL Part B Supplier - Clinic/Group Practice 2062889371 Receives reassigned benefits from 8 practitioners
Practice locations: Mahomet, IL

National Provider Directory

National Provider Directory

Locations

1204 E Oak St
#22
Mahomet, IL 61853
Phone (217) 530-5608

1204 E Oak St
Ste 2-2
Mahomet, IL 61853
Phone (217) 530-5608

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1647561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647561600000",
    "number": "1013666015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1204 E OAK ST STE 2-2",
            "city": "MAHOMET",
            "state": "IL",
            "postal_code": "618532795",
            "telephone_number": "217-530-6708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1204 E OAK ST STE 2-2",
            "city": "MAHOMET",
            "state": "IL",
            "postal_code": "618532795",
            "telephone_number": "217-530-6708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRIT AND GRACE THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-18",
        "last_updated": "2022-03-18",
        "certification_date": "2022-03-18",
        "status": "A",
        "authorized_official_last_name": "MCCLELLAN",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "217-530-5608",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI NUMBER",
            "identifier": "1487209359",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "gritandgracetherapy@gmail.com",
            "affiliation": "N",
            "endpointDescription": "Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1204 E Oak St Ste 2-2",
            "city": "Mahomet",
            "state": "IL",
            "country_code": "US",
            "postal_code": "618532795",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mahomet, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.