Provider Demographics
NPI:1740794940
Name:GRAVGAARD, ZACHARY PRESTON (LCSW)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:PRESTON
Last Name:GRAVGAARD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 DREDGE DR
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-0548
Mailing Address - Country:US
Mailing Address - Phone:406-442-7920
Mailing Address - Fax:406-442-7949
Practice Address - Street 1:3240 DREDGE DR
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-0548
Practice Address - Country:US
Practice Address - Phone:406-442-7920
Practice Address - Fax:406-442-7949
Is Sole Proprietor?:No
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCSW-LIC-26006101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health