Provider Demographics
NPI:1639636665
Name:GRAVES, ZEB KERRENTHIUS III
Entity Type:Individual
Prefix:
First Name:ZEB
Middle Name:KERRENTHIUS
Last Name:GRAVES
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2514 N WHITTIER AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-1462
Mailing Address - Country:US
Mailing Address - Phone:559-341-3036
Mailing Address - Fax:
Practice Address - Street 1:2514 N WHITTIER AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-1462
Practice Address - Country:US
Practice Address - Phone:559-341-3036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst