| Doctor Name: | MS. JENNIFER LEA GRADY |
| NPI Number: | 1063595734 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC-MHSP |
| License Number: | LPC0000002421 |
| Business Practice Address: | 204 Rogosin Dr Ste 4 Elizabethton, TN - 376432965 |
| Business Phone Number: | 4235429900 |
| Business Fax Number: | 4235430900 |
| Mailing Address: | 204 Rogosin Dr Ste 4, ELIZABETHTON |
| State: | TN |
| Postal Code: | 376432965 |
| Phone Number: | 4235429900 |
| Fax Number: | 4235430900 |
| NPI Enumeration Date: | 10/24/2006 |
| NPI Last Update Date: | 03/26/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | LPC0000002421 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |