Provider Demographics
NPI:1841593282
Name:GRAVES, TRINETTE DENISE
Entity Type:Individual
Prefix:
First Name:TRINETTE
Middle Name:DENISE
Last Name:GRAVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 CASA CORONADO AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-3906
Mailing Address - Country:US
Mailing Address - Phone:702-413-2119
Mailing Address - Fax:
Practice Address - Street 1:5901 CASA CORONADO AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-3906
Practice Address - Country:US
Practice Address - Phone:702-413-2119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst