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NPI Code Detail

MEDICARE: MS. TANEISHA JANAE GRAVES LCSW

MEDICARE: MS. TANEISHA JANAE GRAVES LCSW
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
11041C0700XClinical Social Worker7385-CNV

General Provider Information

NPI Number : 1588099865
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TANEISHA JANAE GRAVES LCSW
Provider Business Mailing Address
First Line : 6325 PAGEANT ST
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89031-6300
Country : US
Telephone Number : 702-488-7344
Fax Number :
Provider Business Practice Location Address
First Line : 3247 S MARYLAND PKWY
Second Line :
City : LAS VEGAS
State : NV
Zip : 89109-2412
Country : US
Telephone Number : 702-776-3500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2013
Last Update Date : 01/28/2017

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