Provider Demographics
NPI:1033094495
Name:GRAGE, DEIANEIRA (T-LMHC)
Entity type:Individual
Prefix:
First Name:DEIANEIRA
Middle Name:
Last Name:GRAGE
Suffix:
Gender:F
Credentials:T-LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2127 KOUNTRY LN SE APT 12
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-9319
Mailing Address - Country:US
Mailing Address - Phone:712-297-0613
Mailing Address - Fax:
Practice Address - Street 1:417 1ST AVE. S.
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IA
Practice Address - Zip Code:52314
Practice Address - Country:US
Practice Address - Phone:319-777-1258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA133517101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health