Provider Demographics
NPI:1043022601
Name:GRACEFULION PLLC
Entity type:Organization
Organization Name:GRACEFULION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-450-3939
Mailing Address - Street 1:137 E ELLIOT RD UNIT 1605
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85299-6777
Mailing Address - Country:US
Mailing Address - Phone:520-450-3939
Mailing Address - Fax:
Practice Address - Street 1:230 E PALO VERDE ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-1027
Practice Address - Country:US
Practice Address - Phone:520-459-3939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty