=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053481309
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANA K. GRAVES M.A., L.M.H.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2006
-----------------------------------------------------
Last Update Date | 03/27/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 MAIN ST SUITE D
-----------------------------------------------------
City | EDMONDS
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98020-3079
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-359-9801
-----------------------------------------------------
Fax | 425-778-5259
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9211 OLYMPIC VIEW DR
-----------------------------------------------------
City | EDMONDS
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98020-2396
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-359-9801
-----------------------------------------------------
Fax | 425-778-5259
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | LH00003430
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------