Healthcare Provider Details

I. General information

NPI: 1154226298
Provider Name (Legal Business Name): KELLEY GRAVES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 N OREM BLVD
OREM UT
84057-6601
US

IV. Provider business mailing address

246 N OREM BLVD
OREM UT
84057-6601
US

V. Phone/Fax

Practice location:
  • Phone: 435-610-7955
  • Fax:
Mailing address:
  • Phone: 435-610-7955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number14296034-3904
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: