Provider Demographics
NPI:1013202332
Name:GRAVES, STEPHEN JOHN (MS)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:JOHN
Last Name:GRAVES
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 E GILBERT ST
Mailing Address - Street 2:SAN BERNARDINO COUNTY DEPT. OF BEHAVIORAL HEALTH
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92415-0928
Mailing Address - Country:US
Mailing Address - Phone:909-387-7769
Mailing Address - Fax:909-386-8520
Practice Address - Street 1:820 E GILBERT ST
Practice Address - Street 2:SAN BERNARDINO COUNTY DEPT. OF BEHAVIORAL HEALTH
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92415-0928
Practice Address - Country:US
Practice Address - Phone:909-387-7769
Practice Address - Fax:909-386-8520
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00281736106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist