MEDICARE: GRACEFUL BEHAVIOR SOLUTIONS

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
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1831968965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACEFUL BEHAVIOR SOLUTIONS

Provider Business Mailing Address
First Line	:	113 S. PERRY STREET, SUITE 206 #9861
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046
Country	:	US
Telephone Number	:	229-630-2086
Fax Number	:

Provider Business Practice Location Address
First Line	:	406 JACKSON CIR
Second Line	:
City	:	LAKE PARK
State	:	GA
Zip	:	31636-4928
Country	:	US
Telephone Number	:	229-630-2086
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JESICA PETERSON
Credential	:	BCBA
Telephone Number	:	229-630-2086

Provider Enumeration Date	:	12/29/2023
Last Update Date	:	12/29/2023

Similar Medicare Providers

1861203762 — ANSLEY MADISON TILLMAN
Practice Location Address:

406 JACKSON CIR
LAKE PARK, GA
31636-4928

Practice Phone: 229-251-5589
Practice Fax:

1255146676 — CARLENE HAYNES RBT
Practice Location Address:

406 JACKSON CIR
LAKE PARK, GA
31636-4928

Practice Phone: 229-630-2086
Practice Fax: 888-843-2534

1417755893 — KATE CAROLINE HAIRE
Practice Location Address:

406 JACKSON CIR
LAKE PARK, GA
31636-4928

Practice Phone: 229-630-2086
Practice Fax:

1205597796 — MRS. PATIENCE WAMBUI MBURU
Practice Location Address:

2318 165TH AVENUE CT E
LAKE TAPPS, WA
98391-4928

Practice Phone: 704-780-5124
Practice Fax: 253-409-2806

1598442030 — SHANEKA ELISE JOHNSON
Practice Location Address:

5122 CHESTNUT LAKE DR
CHARLOTTE, NC
28227-4928

Practice Phone: 336-405-2900
Practice Fax:

1104783414 — THE CHILDREN'S LEARNING HUB, LLC
Practice Location Address:

4129 CORINTH CHURCH RD
LAKE PARK, GA
31636-2921

Practice Phone: 229-464-2608
Practice Fax:

Directions to “GRACEFUL BEHAVIOR SOLUTIONS ” Practice Location

Language	Start Address	Practice Location

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.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.