Provider Demographics
NPI:1689459166
Name:ABUNDANT GRACE COUNSELING SERVICES, INC.
Entity type:Organization
Organization Name:ABUNDANT GRACE COUNSELING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:918-269-9511
Mailing Address - Street 1:7220 E 91ST CT
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5300
Mailing Address - Country:US
Mailing Address - Phone:918-269-9511
Mailing Address - Fax:
Practice Address - Street 1:531 E A ST STE 200B
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-4349
Practice Address - Country:US
Practice Address - Phone:918-269-9511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)