Provider Demographics
NPI:1336539923
Name:GRABER, HEIDI (LMHC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:GRABER
Suffix:
Gender:F
Credentials:LMHC
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 19249
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32245-9249
Mailing Address - Country:US
Mailing Address - Phone:904-743-1858
Mailing Address - Fax:904-743-5109
Practice Address - Street 1:921 N DAVIS ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6805
Practice Address - Country:US
Practice Address - Phone:904-359-3857
Practice Address - Fax:904-359-2503
Is Sole Proprietor?:No
Enumeration Date:2015-02-03
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13121101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health