Provider Demographics
NPI:1629386628
Name:GRAUSAM, CARA LEIGH
Entity Type:Individual
Prefix:MRS
First Name:CARA
Middle Name:LEIGH
Last Name:GRAUSAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 MEDICAL GROUP
Mailing Address - Street 2:MENTAL HEALTH CLINIC
Mailing Address - City:GRAND FORKS AFB
Mailing Address - State:ND
Mailing Address - Zip Code:58204
Mailing Address - Country:US
Mailing Address - Phone:701-747-4460
Mailing Address - Fax:
Practice Address - Street 1:319 MEDICAL GROUP
Practice Address - Street 2:MENTAL HEALTH CLINIC
Practice Address - City:GRAND FORKS AFB
Practice Address - State:ND
Practice Address - Zip Code:58204
Practice Address - Country:US
Practice Address - Phone:701-747-4460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-24
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX553331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical