Essential Grace Therapy, PLLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

ESSENTIAL GRACE THERAPY, PLLC

Practice address

12390 Sherburne Ave Ste 210
Becker, MN 55308-9147

Phone

(763) 291-0468

NPI assigned

Oct 16, 2020

Organization subpart

No

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

Authorized official

Name

Mrs. Jodi Ann Smith, MS, LMFTNPI 1437470754

Title

Owner

Phone

(763) 291-0468

Specialties & licenses 2

Addresses

Locations

Practitioners 1

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

• Jodi Ann Smith, M.S., LMFT

  • Marriage & Family Therapist
  • Andover, MN
  • NPI 1437470754
  NPD Authorized official

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

{
    "created_epoch": "1602806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604448000000",
    "number": "1114526548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24910 184TH ST NW",
            "city": "BIG LAKE",
            "state": "MN",
            "postal_code": "553099788",
            "telephone_number": "763-291-0468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12390 SHERBURNE AVE STE 210",
            "city": "BECKER",
            "state": "MN",
            "postal_code": "553089147",
            "telephone_number": "763-291-0468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ESSENTIAL GRACE THERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-16",
        "last_updated": "2020-11-04",
        "certification_date": "2020-11-04",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "JODI",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "763-291-0468",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MS, LMFT"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Victoria L Fenstermacher, CFNP
• Caleb Foster
• Tamara Marie Gay, CMT, ABT, DOULA

• All providers in Becker, MN
• Mental Health Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.