Provider Demographics
NPI:1972266674
Name:MCGRAW, TOMESSA
Entity Type:Individual
Prefix:
First Name:TOMESSA
Middle Name:
Last Name:MCGRAW
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 1:1305 CUMBERLAND AVE STE 225
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-1343
Mailing Address - Country:US
Mailing Address - Phone:317-677-5856
Mailing Address - Fax:
Practice Address - Street 1:1305 CUMBERLAND AVE STE 225
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-1343
Practice Address - Country:US
Practice Address - Phone:317-677-5856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN171M00000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker