Healthcare Provider Details

I. General information

NPI: 1356004881
Provider Name (Legal Business Name): GRACIE BEHAVIOR ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2021
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 BURKESVILLE ST STE 101
COLUMBIA KY
42728-1900
US

IV. Provider business mailing address

312 HURT ST UNIT C
COLUMBIA KY
42728-2311
US

V. Phone/Fax

Practice location:
  • Phone: 270-250-5070
  • Fax: 270-380-1711
Mailing address:
  • Phone: 270-250-5070
  • Fax: 270-380-1711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER MICHELLE CUNDIFF
Title or Position: OWNER/CLINICAL DIRECTOR
Credential: M.ED., B CBA, LBA
Phone: 270-250-5070