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General NPI Number Information
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NPI Number | 1558681767
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Entity Type | Organization
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Legal Business Name | MICHAEL GRAVES PHD PLLC
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Dates
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Enumeration Date | 06/10/2010
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Last Update Date | 06/10/2010
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Provider Practice Location Address
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Address Line | 1500 W 38TH ST STE 47
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City | AUSTIN
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State | TX
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Zip | 78731-6319
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Country | US
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Telephone | 512-986-4837
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Fax | 512-451-9111
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Provider Business Mailing Address
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Address Line | 1500 W 38TH ST STE 47
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City | AUSTIN
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State | TX
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Zip | 78731-6319
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Country | US
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Telephone | 512-986-4837
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Fax | 512-451-9111
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MIKE GRAVES
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Credential | PH.D., PSYCHOLOGIST
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Telephone | 512-986-4837
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 34125
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License Number State | TX
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