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NPI Code Detail

MEDICARE: GRAVES AND ASSOCIATES LLC

MEDICARE: GRAVES AND ASSOCIATES LLC
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
1261QM1300XMulti-Specialty Clinic/Center

General Provider Information

NPI Number : 1235620204
Entity Type Code : Organization
Provider Name (Legal Business Name) : GRAVES AND ASSOCIATES LLC
Provider Business Mailing Address
First Line : 4127 FOOTHILLS ST
Second Line :
City : LARAMIE
State : WY
Zip : 82070-5606
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2020 E GRAND AVE STE 429
Second Line :
City : LARAMIE
State : WY
Zip : 82070-4380
Country : US
Telephone Number : 307-761-3489
Fax Number :
Authorized Official
Title or Position : OWNER
Name : WAYNE GRAVES
Credential : LCSW
Telephone Number : 307-761-3489
Provider Enumeration Date : 05/24/2018
Last Update Date : 02/07/2019

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Directions to “GRAVES AND ASSOCIATES LLC ” Practice Location

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