Provider Demographics
NPI:1639409386
Name:GRAVIS, RONALD NEIL (MA, LPC, LCDC)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:NEIL
Last Name:GRAVIS
Suffix:
Gender:M
Credentials:MA, LPC, LCDC
Other - Prefix:
Other - First Name:RONALD
Other - Middle Name:NEIL
Other - Last Name:GRAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC, LCDC
Mailing Address - Street 1:402 JULIE RIVERS DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3144
Mailing Address - Country:US
Mailing Address - Phone:540-631-5858
Mailing Address - Fax:
Practice Address - Street 1:609 PARK GROVE LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-6190
Practice Address - Country:US
Practice Address - Phone:540-631-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-31
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health