Provider Demographics
NPI:1558681767
Name:MICHAEL GRAVES PHD PLLC
Entity Type:Organization
Organization Name:MICHAEL GRAVES PHD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, PSYCHOLOGIST
Authorized Official - Phone:512-986-4837
Mailing Address - Street 1:1500 W 38TH ST STE 47
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6319
Mailing Address - Country:US
Mailing Address - Phone:512-986-4837
Mailing Address - Fax:512-451-9111
Practice Address - Street 1:1500 W 38TH ST STE 47
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6319
Practice Address - Country:US
Practice Address - Phone:512-986-4837
Practice Address - Fax:512-451-9111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34125103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty