Provider Demographics
NPI:1518470228
Name:GRAFF, TRAVIS JOHNATHON (LCSW, MSW)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:JOHNATHON
Last Name:GRAFF
Suffix:
Gender:M
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 RAY ST
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-4231
Mailing Address - Country:US
Mailing Address - Phone:801-918-6360
Mailing Address - Fax:
Practice Address - Street 1:84 W 4800 S STE 100
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-3781
Practice Address - Country:US
Practice Address - Phone:801-266-1499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-16
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017017828104100000X
UT10500505-3502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker