| The Grace Space, Llc. | |
|
6308 Estates Dr Bastrop LA 71220-9748 | |
| (318) 417-9046 | |
| Not Available |
| Full Name | The Grace Space, Llc. |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 6308 Estates Dr, Bastrop, Louisiana |
| Authorized Official Name and Position | Denitra Beasley (OWNER) |
| Authorized Official Contact | 3184179046 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Grace Space, Llc. 6308 Estates Dr Bastrop LA 71220-9748 Ph: (318) 417-9046 | The Grace Space, Llc. 6308 Estates Dr Bastrop LA 71220-9748 Ph: (318) 417-9046 |
| NPI Number | 1811733074 |
|---|---|
| Provider Enumeration Date | 07/06/2024 |
| Last Update Date | 07/06/2024 |
| Certification Date | 07/06/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811733074 | NPI | - | NPPES |
| 3400511 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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