Provider Demographics
NPI:1205412327
Name:THOMPSON GRAVES, KATHERINE NICHOL
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:NICHOL
Last Name:THOMPSON GRAVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-3702
Mailing Address - Country:US
Mailing Address - Phone:406-315-4800
Mailing Address - Fax:
Practice Address - Street 1:210 SUNNYVIEW LN STE 101
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3128
Practice Address - Country:US
Practice Address - Phone:406-751-8009
Practice Address - Fax:406-257-6463
Is Sole Proprietor?:No
Enumeration Date:2021-03-19
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT48371101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health