Provider Demographics
NPI:1932472149
Name:GRAESER, MARK HEWITT (D MIN)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:HEWITT
Last Name:GRAESER
Suffix:
Gender:M
Credentials:D MIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-2053
Mailing Address - Country:US
Mailing Address - Phone:317-413-6028
Mailing Address - Fax:317-245-2193
Practice Address - Street 1:1525 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46203-2053
Practice Address - Country:US
Practice Address - Phone:317-413-6028
Practice Address - Fax:317-245-2193
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-17
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002334A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health