Provider Demographics
NPI:1417378043
Name:GRAVES, REISHA (MS, MED, BCBA)
Entity Type:Individual
Prefix:
First Name:REISHA
Middle Name:
Last Name:GRAVES
Suffix:
Gender:F
Credentials:MS, MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9009 NW 81ST ST
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-8825
Mailing Address - Country:US
Mailing Address - Phone:405-887-5719
Mailing Address - Fax:
Practice Address - Street 1:9009 NW 81ST ST
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-8825
Practice Address - Country:US
Practice Address - Phone:405-887-5719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-27
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1-19-38951103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst