Provider Demographics
NPI:1407481815
Name:GRACE BEHAVIORAL INTERVENTIONS,LLC
Entity Type:Organization
Organization Name:GRACE BEHAVIORAL INTERVENTIONS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CIJI
Authorized Official - Middle Name:
Authorized Official - Last Name:DUPRE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LBA
Authorized Official - Phone:985-859-1312
Mailing Address - Street 1:114 MARK TWAIN DR APT 12
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70123-2426
Mailing Address - Country:US
Mailing Address - Phone:985-859-1312
Mailing Address - Fax:
Practice Address - Street 1:114 MARK TWAIN DR APT 12
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70123-2426
Practice Address - Country:US
Practice Address - Phone:985-859-1312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-05
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty