Healthcare Provider Details

I. General information

NPI: 1730672171
Provider Name (Legal Business Name): MICHAEL KENNETH GRAUL LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 COLLIERS WAY
WEIRTON WV
26062-5003
US

IV. Provider business mailing address

501 COLLIERS WAY
WEIRTON WV
26062-5003
US

V. Phone/Fax

Practice location:
  • Phone: 304-723-5440
  • Fax:
Mailing address:
  • Phone: 304-723-5440
  • Fax: 478-396-7560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3265
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2606175
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: