Kelly C Grace

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

T1439 Issued in OR

Practice address

959 SE Division St Ste 520
Portland, OR 97214-4672

Phone

(503) 549-4714

NPI assigned

Jan 8, 2016

Last updated

Aug 2, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Second Growth Counseling LLC

  dba Second Growth Counseling

  • Professional Counselor
  • Portland, OR
  • NPI 1871083691

  Marriage & Family Therapist

  NPD Authorized official

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

{
    "created_epoch": "1452211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690934400000",
    "number": "1558727370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 90309",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972900309",
            "telephone_number": "618-339-7497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "959 SE DIVISION ST STE 520",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972144672",
            "telephone_number": "503-549-4714"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9201 SE Foster Rd Ste 206",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972664644",
            "country_code": "US",
            "telephone_number": "503-549-4714",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRACE",
        "first_name": "KELLY",
        "middle_name": "C",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-08",
        "last_updated": "2023-08-02",
        "certification_date": "2021-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "WA",
            "license": "LF61139306",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "OR",
            "license": "T1439",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sydney Graboyes
• Grace Birth and Wellness
• Grace Mavromatis, LLC
• Anthony Michael Grace, LPC
• Evangeline Bruyere Grace, BA IN PSYCHOLOGY
• Matthew Grace
• Megan Grace, LMT
• Stephani G Grace, LPC
• Terresa Diane Grace, CPM, LM
• Thomas Grace, DC

• Marriage & Family Therapist in Portland, OR
• Providers in Portland, OR by specialty
• Marriage & Family Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2023; 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.