Provider Demographics
NPI:1164697157
Name:GRAVES, BRIANNE (MS)
Entity Type:Individual
Prefix:MRS
First Name:BRIANNE
Middle Name:
Last Name:GRAVES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3517 PEELER RD
Mailing Address - Street 2:UNIT 11
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-0616
Mailing Address - Country:US
Mailing Address - Phone:904-744-4196
Mailing Address - Fax:
Practice Address - Street 1:3517 PEELER RD
Practice Address - Street 2:UNIT 11
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-0616
Practice Address - Country:US
Practice Address - Phone:904-744-4196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral