Healthcare Provider Details

I. General information

NPI: 1164511234
Provider Name (Legal Business Name): BETH J MCGRAW PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETH J MCGRAW

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 12/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BODIN CIR, TRAVIS AFB 60 MDOS SGOH
FAIRFIELD CA
94535
US

IV. Provider business mailing address

101 BODIN CIR, TRAVIS AFB 60 MDOS SGOH
FAIRFIELD CA
94535
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-5174
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: