Healthcare Provider Details

I. General information

NPI: 1528848199
Provider Name (Legal Business Name): GRACE BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7412 BODE FERRY RD
JEFFERSON CITY MO
65101-7600
US

IV. Provider business mailing address

7412 BODE FERRY RD
JEFFERSON CITY MO
65101-7600
US

V. Phone/Fax

Practice location:
  • Phone: 573-469-2433
  • Fax: 573-550-2436
Mailing address:
  • Phone: 573-469-2433
  • Fax: 573-550-2436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: LEANNA A FOWLDS
Title or Position: DIRECTOR/ THERAPIST
Credential: LCSW
Phone: 573-469-2433