Healthcare Provider Details

I. General information

NPI: 1831002070
Provider Name (Legal Business Name): GRACE MCGUFFIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6004 WALDEN DR
KNOXVILLE TN
37919-6337
US

IV. Provider business mailing address

5554 RESEDA BLVD STE 203
TARZANA CA
91356-6212
US

V. Phone/Fax

Practice location:
  • Phone: 865-766-5775
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: