Provider Demographics
NPI:1609180496
Name:GRAGES, NICOLE (MA,LMFT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:GRAGES
Suffix:
Gender:F
Credentials:MA,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11334 86TH AVE N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4528
Mailing Address - Country:US
Mailing Address - Phone:763-255-2125
Mailing Address - Fax:763-255-2126
Practice Address - Street 1:11334 86TH AVE N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4528
Practice Address - Country:US
Practice Address - Phone:763-255-2125
Practice Address - Fax:763-255-2126
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1824106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist