Provider Demographics
NPI:1407255722
Name:GRAVES-GARRETT, ROSITA LANE' (MED)
Entity Type:Individual
Prefix:MS
First Name:ROSITA
Middle Name:LANE'
Last Name:GRAVES-GARRETT
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:ROSITA
Other - Middle Name:LANE'
Other - Last Name:GRAVES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED
Mailing Address - Street 1:40 NE 65TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-1235
Mailing Address - Country:US
Mailing Address - Phone:405-246-5704
Mailing Address - Fax:
Practice Address - Street 1:40 NE 65TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-1235
Practice Address - Country:US
Practice Address - Phone:405-246-5704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor