Provider Demographics
NPI:1295904563
Name:GRAVES, JAMES STEPHEN (PHD, PSYD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:STEPHEN
Last Name:GRAVES
Suffix:
Gender:M
Credentials:PHD, PSYD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:572 E GREEN ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2045
Mailing Address - Country:US
Mailing Address - Phone:626-844-0212
Mailing Address - Fax:626-844-7101
Practice Address - Street 1:572 E GREEN ST
Practice Address - Street 2:SUITE 304
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2085
Practice Address - Country:US
Practice Address - Phone:626-844-0212
Practice Address - Fax:626-844-7101
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY18196103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP18196Medicare PIN