# HOME OF GRACE COUNSELING ARIZONA LLC

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

## Provider details

- **NPI number:** 1356119101
- **Authorized official:** TEODOSIO GUTIERREZ (DIRECTOR OF OUTPATIENT SERVICES)
- **Authorized official phone:** (480) 757-7952

## Contact information

- **Practice address:** 4700 S MILL AVE STE 5, TEMPE, AZ 85282-6736
- **Practice address phone:** (480) 757-7952
- **Mailing address:** 4700 S MILL AVE STE 5, TEMPE, AZ 85282-6736
- **Mailing address phone:** (480) 757-7952

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |

## Other

- **Enumeration date:** 12/12/2023
- **Last updated:** 08/16/2024