# GRACE THERAPY AND WELLNESS CENTER

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

## Provider details

- **NPI number:** 1720758378
- **Authorized official:** GRACE MARTIN LMFT (FOUNDER)
- **Authorized official phone:** (786) 239-5280

## Contact information

- **Practice address:** 105 N OAK PARK AVE STE 4C, OAK PARK, IL 60301-1364
- **Practice address phone:** (773) 423-8447
- **Mailing address:** 105 N OAK PARK AVE \# 2B, OAK PARK, IL 60301-1364
- **Mailing address phone:** (773) 423-8447

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 104100000X | Social Worker | — | NULL | — |
| 104100000X | Social Worker | — | — | — |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |

## Other

- **Enumeration date:** 09/15/2021
- **Last updated:** 12/06/2023