Healthcare Provider Details

I. General information

NPI: 1134574049
Provider Name (Legal Business Name): DIANA LEE GRAVES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANA LEE BURTON

II. Dates (important events)

Enumeration Date: 04/28/2016
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 E GRAND
HIGHLAND PARK MI
48203-3105
US

IV. Provider business mailing address

247 E GRAND
HIGHLAND PARK MI
48203-3105
US

V. Phone/Fax

Practice location:
  • Phone: 313-404-3187
  • Fax:
Mailing address:
  • Phone: 313-404-3187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: