Provider Demographics
NPI:1083050371
Name:GRAVES, MICHELLE LEE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEE
Last Name:GRAVES
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:MICA
Other - Middle Name:
Other - Last Name:GRAVES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:4641 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-3511
Mailing Address - Country:US
Mailing Address - Phone:303-478-0768
Mailing Address - Fax:
Practice Address - Street 1:1280 W 47TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-2317
Practice Address - Country:US
Practice Address - Phone:303-478-0768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0011775101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health