Provider Demographics
NPI:1831762087
Name:GRAYCE, JAMIE DARBY (MS)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:DARBY
Last Name:GRAYCE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:KRYSTIN
Other - Last Name:DARBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:625 CORPORATE BLVD
Mailing Address - Street 2:
Mailing Address - City:BREAUX BRIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70517-4324
Mailing Address - Country:US
Mailing Address - Phone:337-230-0635
Mailing Address - Fax:
Practice Address - Street 1:625 CORPORATE BLVD
Practice Address - Street 2:
Practice Address - City:BREAUX BRIDGE
Practice Address - State:LA
Practice Address - Zip Code:70517-4324
Practice Address - Country:US
Practice Address - Phone:337-230-0635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8786101YM0800X
171M00000X
LALPC8786101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator