Provider Demographics
NPI:1649624180
Name:MCGRAW, JESSICA (LLPC, CAADC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MCGRAW
Suffix:
Gender:F
Credentials:LLPC, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 S GARFIELD AVENUE
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-3465
Mailing Address - Country:US
Mailing Address - Phone:231-346-5216
Mailing Address - Fax:231-943-2590
Practice Address - Street 1:445 E STATE ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-2603
Practice Address - Country:US
Practice Address - Phone:231-922-4810
Practice Address - Fax:231-943-2590
Is Sole Proprietor?:No
Enumeration Date:2016-04-21
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016117101YS0200X, 101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1629431713Medicaid
MI1184087272Medicaid