MEDICARE: TERRIANN V GRAVES LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	ADDC.0000048	CO
2	101YM0800X	Mental Health Counselor	LPCC.0017383	CO

General Provider Information

NPI Number	:	1225798960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRIANN V GRAVES LPCC

Provider Business Mailing Address
First Line	:	5731 N ACADEMY BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-3684
Country	:	US
Telephone Number	:	888-228-2384
Fax Number	:

Provider Business Practice Location Address
First Line	:	5731 N ACADEMY BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-3684
Country	:	US
Telephone Number	:	720-439-8348
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2021
Last Update Date	:	12/21/2021

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