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Organization
GRACE COUPLE AND FAMILY THERAPY
Active
Organization
GRACE COUPLE AND FAMILY THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRACE MARTIN LMFT (CEO)
(786) 239-5280
Entity
Organization
Contact information
Practice address
105 N OAK PARK AVE # 2B, OAK PARK, IL 60301-1364
(773) 423-8447
Mailing address
105 N OAK PARK AVE # 2B, OAK PARK, IL 60301-1364
(773) 423-8447
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
NULL
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
—
NULL
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
Primary
—
NULL
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Enumeration date
11/24/2019
Last updated
12/06/2023
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