Grace Counseling Services

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Legal business name

GRACE COUNSELING SERVICES

Practice address

21471 Ulysses St. NE
East Bethel, MN 55011

Phone

(763) 413-8838

Fax

(763) 413-8878

NPI assigned

Jul 24, 2023

Organization subpart

No

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

Authorized official

Name

Mrs. Penny Main-Bennett, LADC

Title

Owner & Director

Phone

(763) 413-8838

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1690156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690156800000",
    "number": "1861172991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21471 ULYSSES ST. NE",
            "city": "EAST BETHEL",
            "state": "MN",
            "postal_code": "55011",
            "telephone_number": "763-413-8838",
            "fax_number": "763-413-8878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21471 ULYSSES ST. NE",
            "city": "EAST BETHEL",
            "state": "MN",
            "postal_code": "55011",
            "telephone_number": "763-413-8838",
            "fax_number": "763-413-8878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE COUNSELING SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-24",
        "last_updated": "2023-07-24",
        "certification_date": "2023-07-24",
        "status": "A",
        "authorized_official_last_name": "MAIN-BENNETT",
        "authorized_official_first_name": "PENNY",
        "authorized_official_title_or_position": "OWNER & DIRECTOR",
        "authorized_official_telephone_number": "763-413-8838",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LADC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "640067100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Addiction (Substance Use Disorder) Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 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.