MEDICARE: NOVIS INITIIS PSYCHOTHERAPY PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	102L00000X	Psychoanalyst
2	103TC0700X	Clinical Psychologist
3	103TC2200X	Clinical Child & Adolescent Psychologist
4	103TF0000X	Family Psychologist
5	103T00000X	Psychologist

General Provider Information

NPI Number	:	1770415960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVIS INITIIS PSYCHOTHERAPY PLLC

Provider Business Mailing Address
First Line	:	PO BOX 1864
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98668-1864
Country	:	US
Telephone Number	:	720-295-5853
Fax Number	:	866-466-5083

Provider Business Practice Location Address
First Line	:	717 NE 61ST ST STE 206
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98665-8753
Country	:	US
Telephone Number	:	720-295-5853
Fax Number	:	866-466-5083

Authorized Official
Title or Position	:	PSYCHOLOGIST / CO-OWNER
Name	:	DR. DOUGLAS ALLAN GRAVES
Credential	:	PSYD
Telephone Number	:	720-295-5853

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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