# GRACE RANCH

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255676011
- **Authorized official:** MRS. SUSAN HARDENBROOK LADC, LADC-S (OWNER)
- **Authorized official phone:** (702) 370-8912

## Contact information

- **Practice address:** 7729 MAVERICK ST, LAS VEGAS, NV 89131-2113
- **Practice address phone:** (702) 370-8912
- **Mailing address:** 7729 MAVERICK ST, LAS VEGAS, NV 89131-2113
- **Mailing address phone:** (702) 370-8912

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | 00202-S | NV | Yes |
| 101YP1600X | Pastoral Counselor | — | NV | — |
| 106H00000X | Marriage & Family Therapist | — | NV | — |

## Other

- **Enumeration date:** 12/05/2012
- **Last updated:** 12/05/2012