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General NPI Number Information
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NPI Number | 1639992977
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Entity Type | Organization
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Legal Business Name | GRACIE BEHAVIOR ASSOCIATES, LLC
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Dates
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Enumeration Date | 11/05/2024
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 220 OFFICE PARK DR
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City | COLUMBIA
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State | KY
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Zip | 42728-1381
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Country | US
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Telephone | 270-250-5070
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Fax | 270-380-1711
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Provider Business Mailing Address
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Address Line | 203 BURKESVILLE ST STE 101
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City | COLUMBIA
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State | KY
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Zip | 42728-1900
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Country | US
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Telephone | 270-250-5070
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Fax | 270-380-1711
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Authorized Official
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Title or Position | OWNER/BCBA
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Name | JENNIFER MICHELLE CUNDIFF
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Credential | M.ED., BCBA, LBA
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Telephone | 859-230-0559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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