Provider Demographics
NPI:1508919176
Name:GRAESER, TED (LPC)
Entity Type:Individual
Prefix:
First Name:TED
Middle Name:
Last Name:GRAESER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3960 BROADWAY BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-2593
Mailing Address - Country:US
Mailing Address - Phone:214-703-3317
Mailing Address - Fax:214-703-3948
Practice Address - Street 1:3960 BROADWAY BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-2593
Practice Address - Country:US
Practice Address - Phone:214-703-3317
Practice Address - Fax:214-703-3948
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12521101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor