MEDICARE: MRS. CARI GRAVEL LCSW

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
1	1041C0700X	Clinical Social Worker
2	104100000X	Social Worker

General Provider Information

NPI Number	:	1376061127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARI GRAVEL LCSW

Provider Business Mailing Address
First Line	:	PO BOX 904
Second Line	:
City	:	MAUD
State	:	OK
Zip	:	74854-0904
Country	:	US
Telephone Number	:	405-394-5298
Fax Number	:

Provider Business Practice Location Address
First Line	:	9905 S PENNSYLVANIA AVE STE A
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-6920
Country	:	US
Telephone Number	:	405-394-5298
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2017
Last Update Date	:	12/20/2022

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