Provider Demographics
NPI:1295001394
Name:GRAVES, COURTNEY M (LPC)
Entity Type:Individual
Prefix:MISS
First Name:COURTNEY
Middle Name:M
Last Name:GRAVES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2075 AQUEDUCT DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-2861
Mailing Address - Country:US
Mailing Address - Phone:678-516-9732
Mailing Address - Fax:
Practice Address - Street 1:2075 AQUEDUCT DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-2861
Practice Address - Country:US
Practice Address - Phone:678-516-9732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011009849101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional