Provider Demographics
NPI:1467663302
Name:GRAVES, TODD DAVIS (LMFT)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:DAVIS
Last Name:GRAVES
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 E RIVERSIDE DR STE 3A
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7127
Mailing Address - Country:US
Mailing Address - Phone:435-767-8140
Mailing Address - Fax:
Practice Address - Street 1:393 E RIVERSIDE DR STE 3A
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7127
Practice Address - Country:US
Practice Address - Phone:435-767-8140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5822683-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist