Provider Demographics
NPI:1639891005
Name:GRAVES, MEGHAN ROSE (RBT)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:ROSE
Last Name:GRAVES
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:589 IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-5512
Mailing Address - Country:US
Mailing Address - Phone:509-998-9185
Mailing Address - Fax:
Practice Address - Street 1:589 IOWA AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-5512
Practice Address - Country:US
Practice Address - Phone:509-998-9185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBACB670810106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician