Provider Demographics
NPI:1922373240
Name:GRAVEN, REBECCA DAISY
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:DAISY
Last Name:GRAVEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:DAISY
Other - Last Name:LUTHULTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1010 1/2 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93307
Mailing Address - Country:US
Mailing Address - Phone:661-321-0234
Mailing Address - Fax:
Practice Address - Street 1:2525 N CHESTER AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-1770
Practice Address - Country:US
Practice Address - Phone:661-868-1789
Practice Address - Fax:661-321-9856
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC13671214OtherSUBSTANCE ABUSE PROGRAM MANAGER