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General NPI Number Information
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NPI Number | 1821523580
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Entity Type | Individual
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Provider Name | STACEY LYNN GRAVES MA, LCPC
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Gender | Female
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Dates
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Enumeration Date | 05/01/2017
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Last Update Date | 08/31/2020
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Provider Practice Location Address
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Address Line | 913 SW HIGGINS AVE STE 202
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City | MISSOULA
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State | MT
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Zip | 59803-1423
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Country | US
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Telephone | 406-690-7753
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7874
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City | MISSOULA
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State | MT
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Zip | 59807-7874
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Country | US
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Telephone | 406-690-7753
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Fax |
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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 | BBH-LCPC-LIC-18899
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License Number State | MT
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