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NPI Code Detail

MEDICARE: MCKENZIE GRUBBS

MEDICARE: MCKENZIE GRUBBS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior AnalystVA

General Provider Information

NPI Number : 1114697414
Entity Type Code : Individual
Provider Name (Legal Business Name) : MCKENZIE GRUBBS
Provider Business Mailing Address
First Line : 4225 PORTSMOUTH BLVD STE B
Second Line :
City : CHESAPEAKE
State : VA
Zip : 23321-2154
Country : US
Telephone Number : 757-335-4380
Fax Number :
Provider Business Practice Location Address
First Line : 4225 PORTSMOUTH BLVD STE B
Second Line :
City : CHESAPEAKE
State : VA
Zip : 23321-2154
Country : US
Telephone Number : 757-335-4380
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/17/2021
Last Update Date : 05/04/2026

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Directions to “ MCKENZIE GRUBBS ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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