Provider Demographics
NPI:1700814134
Name:GRABER, RICK ALLEN (PHD)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:ALLEN
Last Name:GRABER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 TUDOR CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5902
Mailing Address - Country:US
Mailing Address - Phone:907-565-4000
Mailing Address - Fax:907-565-4011
Practice Address - Street 1:4105 TUDOR CENTRE DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5902
Practice Address - Country:US
Practice Address - Phone:907-565-4000
Practice Address - Fax:907-565-4011
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK296103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMH6578Medicaid