Provider Demographics
NPI:1326163387
Name:GRAVES, BRANDON JOSEPH (BFA)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:JOSEPH
Last Name:GRAVES
Suffix:
Gender:M
Credentials:BFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 SE 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-3703
Mailing Address - Country:US
Mailing Address - Phone:971-533-1782
Mailing Address - Fax:
Practice Address - Street 1:2507 CHRISTIE DRIVE
Practice Address - Street 2:
Practice Address - City:MARYLHURST
Practice Address - State:OR
Practice Address - Zip Code:97036
Practice Address - Country:US
Practice Address - Phone:503-635-3416
Practice Address - Fax:503-697-6932
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor