Provider Demographics
NPI:1497102925
Name:GRAVES, MISTI SUSANNE
Entity Type:Individual
Prefix:MRS
First Name:MISTI
Middle Name:SUSANNE
Last Name:GRAVES
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MISTI
Other - Middle Name:SUSANNE
Other - Last Name:BATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2302 BRAZOS DR
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:TX
Mailing Address - Zip Code:76210-6406
Mailing Address - Country:US
Mailing Address - Phone:214-695-3371
Mailing Address - Fax:
Practice Address - Street 1:2302 BRAZOS DR
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:TX
Practice Address - Zip Code:76210-6406
Practice Address - Country:US
Practice Address - Phone:214-695-3371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst