Healthcare Provider Details

I. General information

NPI: 1831762087
Provider Name (Legal Business Name): JAMIE DARBY GRAYCE MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2021
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 CORPORATE BLVD
BREAUX BRIDGE LA
70517-4324
US

IV. Provider business mailing address

143 RIDGEWAY DR STE 235
LAFAYETTE LA
70503-3410
US

V. Phone/Fax

Practice location:
  • Phone: 337-230-0635
  • Fax:
Mailing address:
  • Phone: 337-230-0635
  • Fax: 855-270-9526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8786
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC8786
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: