Provider Demographics
NPI:1609189992
Name:GRAVES, CYNTHIA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:
Last Name:GRAVES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:CINDY
Other - Middle Name:
Other - Last Name:GRAVES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1445 WEST 1100 NORTH
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-6018
Mailing Address - Country:US
Mailing Address - Phone:801-369-5988
Mailing Address - Fax:801-377-8478
Practice Address - Street 1:1445 WEST 1100 NORTH
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-6018
Practice Address - Country:US
Practice Address - Phone:801-369-5988
Practice Address - Fax:801-377-8478
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-15
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
UT7675500-3501101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor