Healthcare Provider Details

I. General information

NPI: 1235149295
Provider Name (Legal Business Name): JOSEPH JOHN GRACA PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 BISBEE RD
BISBEE AZ
85603-1140
US

IV. Provider business mailing address

PO BOX 1667
BISBEE AZ
85603-2667
US

V. Phone/Fax

Practice location:
  • Phone: 520-432-2042
  • Fax: 520-432-2098
Mailing address:
  • Phone: 320-282-8857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4394
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: