Healthcare Provider Details

I. General information

NPI: 1326962838
Provider Name (Legal Business Name): DAVID GRAEBE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19929 E 61ST DR
AURORA CO
80019-2286
US

IV. Provider business mailing address

19929 E 61ST DR
AURORA CO
80019-2286
US

V. Phone/Fax

Practice location:
  • Phone: 631-384-9427
  • Fax:
Mailing address:
  • Phone: 631-384-9427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number.0000492
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: