Healthcare Provider Details

I. General information

NPI: 1124336144
Provider Name (Legal Business Name): STEPHEN GRAEF PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2010
Last Update Date: 01/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 KENNY RD STE 3100
COLUMBUS OH
43221-3502
US

IV. Provider business mailing address

2050 KENNY RD STE 3100
COLUMBUS OH
43221-3502
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-2432
  • Fax: 614-293-2910
Mailing address:
  • Phone: 614-293-2432
  • Fax: 614-293-2910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number7115
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: