MEDICARE: KEA ILEAH SMITH-GRAVES

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1952252462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEA ILEAH SMITH-GRAVES

Provider Business Mailing Address
First Line	:	13958 COTTINGHAM ST APT 7201
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77048-1962
Country	:	US
Telephone Number	:	281-802-8834
Fax Number	:

Provider Business Practice Location Address
First Line	:	13958 COTTINGHAM ST APT 7201
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77048-1962
Country	:	US
Telephone Number	:	281-802-8834
Fax Number	:

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

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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