Healthcare Provider Details

I. General information

NPI: 1073420675
Provider Name (Legal Business Name): LOUIS BERTRAND GRAVES III LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 N MAIN ST
MONTICELLO KY
42633-2000
US

IV. Provider business mailing address

1525 N MAIN ST
MONTICELLO KY
42633-2000
US

V. Phone/Fax

Practice location:
  • Phone: 606-307-3043
  • Fax:
Mailing address:
  • Phone: 606-307-3043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW00001782
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLCSW00001782
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: