Organization
ESSENTIAL GRACE THERAPY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JODI ANN SMITH MS, LMFT (OWNER)
(763) 291-0468
Entity
Organization
Contact information
Practice address
12390 SHERBURNE AVE STE 210, BECKER, MN 55308-9147
(763) 291-0468
Mailing address
24910 184TH ST NW, BIG LAKE, MN 55309-9788
(763) 291-0468
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
10/16/2020
Last updated
11/04/2020
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