Healthcare Provider Details

I. General information

NPI: 1104515675
Provider Name (Legal Business Name): BRIAN GRACE BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 COPPER CREEK DR STE G
PLEASANT HILL IA
50327-7091
US

IV. Provider business mailing address

1225 COPPER CREEK DR STE G
PLEASANT HILL IA
50327-7091
US

V. Phone/Fax

Practice location:
  • Phone: 515-207-5046
  • Fax: 515-644-4977
Mailing address:
  • Phone: 515-207-5046
  • Fax: 515-644-4977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: