| Doctor Name: | DR. GRACE PENA |
| NPI Number: | 1821051491 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSYD, LMHC |
| License Number: | MH 5773 |
| Business Practice Address: | 600 U.s. Hwy 27 Suite # 1 Minneola, FL - 347156000 |
| Business Phone Number: | 4072097492 |
| Business Fax Number: | 3522418372 |
| Mailing Address: | 316 Brimming Lake Rd, MINNEOLA |
| State: | FL |
| Postal Code: | 347156000 |
| Phone Number: | 4072097492 |
| Fax Number: | 3522418372 |
| NPI Enumeration Date: | 04/06/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | MH 5773 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |