Organization
CAROLE A. GRADY LPCC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROLE A GRADY LPCC, MED, CEP (SOLE-PROPRIETER)
(575) 202-7576
Entity
Organization
Contact information
Practice address
1570 W PICACHO AVE, LAS CRUCES, NM 88005-2375
(575) 202-7576
(575) 222-0659
Mailing address
145 ROBERTS DR, LAS CRUCES, NM 88005-3073
(575) 202-7576
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1944
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
59482788
—
NM
Enumeration date
07/10/2017
Last updated
07/10/2017
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