Provider Demographics
NPI:1235914672
Name:GRAVLEY, JAMES NEAL (MSFP, MED)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:NEAL
Last Name:GRAVLEY
Suffix:
Gender:M
Credentials:MSFP, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6515 JESSE CT
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-6986
Mailing Address - Country:US
Mailing Address - Phone:503-927-4087
Mailing Address - Fax:
Practice Address - Street 1:6515 JESSE CT
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-6986
Practice Address - Country:US
Practice Address - Phone:503-927-4087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health