Provider Demographics
NPI:1790405769
Name:GRAVES, PATRICIA (MA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:GRAVES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 E 10TH ST STE L
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-4083
Mailing Address - Country:US
Mailing Address - Phone:209-666-1003
Mailing Address - Fax:
Practice Address - Street 1:35 E 10TH ST STE L
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-4083
Practice Address - Country:US
Practice Address - Phone:209-666-1003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT134066106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist