Provider Demographics
NPI:1609105543
Name:GROVES, JAMES KEVIN (MSW LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:KEVIN
Last Name:GROVES
Suffix:
Gender:M
Credentials:MSW LCSW
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Mailing Address - Street 1:415 MULBERRY STREET
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47713-1230
Mailing Address - Country:US
Mailing Address - Phone:812-423-7791
Mailing Address - Fax:812-422-7558
Practice Address - Street 1:4001 JOHN STREET
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0216
Practice Address - Country:US
Practice Address - Phone:812-473-3144
Practice Address - Fax:812-422-7558
Is Sole Proprietor?:No
Enumeration Date:2009-12-23
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006989A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100240880Medicaid
IN839090010OtherMEDICARE
IN000000874786OtherANTHEM
12697748OtherCAQH