Provider Demographics
NPI:1831322551
Name:GRAVES BARNETT, MICAH JEAN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MICAH
Middle Name:JEAN
Last Name:GRAVES BARNETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:MICAH
Other - Middle Name:JEAN
Other - Last Name:GRAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2806 SW 77TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-4608
Mailing Address - Country:US
Mailing Address - Phone:405-203-6793
Mailing Address - Fax:405-203-6793
Practice Address - Street 1:1601 SW 89TH ST STE F200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-6358
Practice Address - Country:US
Practice Address - Phone:405-787-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-27
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK35081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical