Provider Demographics
NPI:1295066447
Name:GRAVETT, CHRISTOPHER JON (LCSW)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JON
Last Name:GRAVETT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 242
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-0242
Mailing Address - Country:US
Mailing Address - Phone:435-610-1896
Mailing Address - Fax:
Practice Address - Street 1:53 S 700 E
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-3128
Practice Address - Country:US
Practice Address - Phone:435-610-1896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-27
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7014686-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical