MEDICARE: DEANNA M GRAVES LPC

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1659582625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANNA M GRAVES LPC

Provider Business Mailing Address
First Line	:	3355 BEE CAVE RD STE 508
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-6682
Country	:	US
Telephone Number	:	512-221-7311
Fax Number	:

Provider Business Practice Location Address
First Line	:	3355 BEE CAVE RD STE 508
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-6682
Country	:	US
Telephone Number	:	512-221-7311
Fax Number	:

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	05/08/2013

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