Doctor Name: | MISS JESSICA ANN GRAYBURN |
NPI Number: | 1871935205 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA, AT, IMH 11373 |
License Number: | IMH 11373 |
Business Practice Address: | 633 Umatilla Blvd Umatilla, FL - 327848418 |
Business Phone Number: | 3526698000 |
Business Fax Number: | |
Mailing Address: | 633 Umatilla Blvd, UMATILLA |
State: | FL |
Postal Code: | 327848418 |
Phone Number: | 3526698000 |
Fax Number: | |
NPI Enumeration Date: | 07/26/2013 |
NPI Last Update Date: | 07/26/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | IMH 11373 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |