Provider Demographics
NPI:1114918661
Name:GRAUE II, JOHN R (MS AND THD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:GRAUE II
Suffix:
Gender:M
Credentials:MS AND THD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 E 20TH ST
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-0928
Mailing Address - Country:US
Mailing Address - Phone:417-627-9601
Mailing Address - Fax:471-627-9032
Practice Address - Street 1:1505 E 20TH ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-0928
Practice Address - Country:US
Practice Address - Phone:417-627-9601
Practice Address - Fax:417-627-9032
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01724103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling