Provider Demographics
NPI:1174927354
Name:GRACIA, KRISTY (LPCC-S)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:GRACIA
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:
Other - Last Name:SEIGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 29
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402
Mailing Address - Country:US
Mailing Address - Phone:419-352-5387
Mailing Address - Fax:
Practice Address - Street 1:5565 AIRPORT HWY STE 100&203
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-7379
Practice Address - Country:US
Practice Address - Phone:419-720-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-16
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1000010101YP2500X
OHE.1600095-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional