Provider Demographics
NPI:1417152562
Name:GRAVES OSBORN, CARMEN (BS, QMRP, MS)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:GRAVES OSBORN
Suffix:
Gender:F
Credentials:BS, QMRP, MS
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:
Other - Last Name:GRAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS, CM
Mailing Address - Street 1:1538 MUTZ DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-2211
Mailing Address - Country:US
Mailing Address - Phone:317-752-3404
Mailing Address - Fax:317-622-1562
Practice Address - Street 1:1538 MUTZ DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-2211
Practice Address - Country:US
Practice Address - Phone:317-752-3404
Practice Address - Fax:317-622-1562
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered171M00000XOther Service ProvidersCase Manager/Care Coordinator