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General NPI Number Information
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NPI Number | 1093414567
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Entity Type | Individual
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Provider Name | BRANDY MICHELLE GRAVES
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Gender | Female
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Dates
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Enumeration Date | 02/23/2023
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 2900 ROOSEVELT RD
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City | KENOSHA
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State | WI
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Zip | 53143-4642
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Country | US
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Telephone | 262-997-9411
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Fax | 262-997-3844
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Provider Business Mailing Address
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Address Line | PO BOX 488
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City | BRISTOL
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State | WI
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Zip | 53104-0488
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Country | US
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Telephone | 262-997-9411
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Fax | 262-997-3844
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 8436226
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License Number State | WI
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