Healthcare Provider Details

I. General information

NPI: 1770415960
Provider Name (Legal Business Name): NOVIS INITIIS PSYCHOTHERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 NE 61ST ST STE 206
VANCOUVER WA
98665-8753
US

IV. Provider business mailing address

PO BOX 1864
VANCOUVER WA
98668-1864
US

V. Phone/Fax

Practice location:
  • Phone: 720-295-5853
  • Fax: 866-466-5083
Mailing address:
  • Phone: 720-295-5853
  • Fax: 866-466-5083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. DOUGLAS ALLAN GRAVES
Title or Position: PSYCHOLOGIST / CO-OWNER
Credential: PSYD
Phone: 720-295-5853