Provider Demographics
NPI:1205711587
Name:TABLE OF GRACE CLINICAL COUNSELING, LLC
Entity type:Organization
Organization Name:TABLE OF GRACE CLINICAL COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRODY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:RIKE
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:937-825-2736
Mailing Address - Street 1:175 LAKENGREN DR
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-2870
Mailing Address - Country:US
Mailing Address - Phone:937-825-2736
Mailing Address - Fax:
Practice Address - Street 1:6 S 2ND ST STE 824
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-2869
Practice Address - Country:US
Practice Address - Phone:937-387-8601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)