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NPI Code Detail

MEDICARE: VANESSA P. GRAF

MEDICARE: VANESSA P. GRAF
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist569CO

General Provider Information

NPI Number : 1063580009
Entity Type Code : Organization
Provider Name (Legal Business Name) : VANESSA P. GRAF
Provider Business Mailing Address
First Line : 4760 FLINTRIDGE DR STE 250
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80918-4264
Country : US
Telephone Number : 719-260-6262
Fax Number : 719-260-0780
Provider Business Practice Location Address
First Line : 4760 FLINTRIDGE DR STE 250
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80918-4264
Country : US
Telephone Number : 719-260-6262
Fax Number : 719-260-0780
Authorized Official
Title or Position : OWNER
Name : DR. VANESSA P GRAF
Credential : PSYD, LMFT, PC
Telephone Number : 719-260-6262
Provider Enumeration Date : 11/30/2006
Last Update Date : 08/22/2020

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