Provider Demographics
NPI:1134630965
Name:GRAVEEN, CASSIE M (LPC-IT, MSAT)
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:M
Last Name:GRAVEEN
Suffix:
Gender:F
Credentials:LPC-IT, MSAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:R5743 MERIDIAN RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:WI
Mailing Address - Zip Code:54411-9317
Mailing Address - Country:US
Mailing Address - Phone:414-578-7253
Mailing Address - Fax:
Practice Address - Street 1:501 DIVISION ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-6206
Practice Address - Country:US
Practice Address - Phone:715-301-0667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-19
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3311-226101YM0800X
WI3311101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional