Basic Information
| Provider Information | |||||||||
| NPI: | 1598287716 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAMOUR | ||||||||
| FirstName: | GRACE | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MHC-LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14342 84TH RD FL 3 | ||||||||
| Address2: | |||||||||
| City: | BRIARWOOD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114352228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9293225570 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10470 QUEENS BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | FOREST HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113753694 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182756010 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2017 | ||||||||
| LastUpdateDate: | 07/10/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | P05397 | NY | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.