Provider Demographics
NPI:1891961926
Name:GRAVES, GARY EUGENE (ASSOCIATE CLINICAL S)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:EUGENE
Last Name:GRAVES
Suffix:
Gender:M
Credentials:ASSOCIATE CLINICAL S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81711 HWY 111
Mailing Address - Street 2:STE 101
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201
Mailing Address - Country:US
Mailing Address - Phone:760-347-2398
Mailing Address - Fax:760-347-6468
Practice Address - Street 1:81711 HWY 111
Practice Address - Street 2:STE 101
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201
Practice Address - Country:US
Practice Address - Phone:760-347-2398
Practice Address - Fax:760-347-2398
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSW162831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical