Provider Demographics
NPI:1639907215
Name:KHAZRAI, GRACIELA (LCSW)
Entity type:Individual
Prefix:
First Name:GRACIELA
Middle Name:
Last Name:KHAZRAI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4151 S SPLENDOR CT
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-6617
Mailing Address - Country:US
Mailing Address - Phone:480-512-2644
Mailing Address - Fax:
Practice Address - Street 1:4151 S SPLENDOR CT
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-6617
Practice Address - Country:US
Practice Address - Phone:480-512-2644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children