Provider Demographics
NPI:1821660648
Name:GRAVES, KEVIN (MS, AMFT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:GRAVES
Suffix:
Gender:M
Credentials:MS, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 N VENDOME ST APT 3
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-2850
Mailing Address - Country:US
Mailing Address - Phone:213-713-5202
Mailing Address - Fax:
Practice Address - Street 1:10323 SANTA MONICA BLVD
Practice Address - Street 2:STE 106
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5056
Practice Address - Country:US
Practice Address - Phone:805-409-7219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA126593106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist