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NPI Code Detail

MEDICARE: CRYSTAL JANAI' GRAVES LCSW

MEDICARE: CRYSTAL JANAI' 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 Worker9018OK

General Provider Information

NPI Number : 1780367326
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTAL JANAI' GRAVES LCSW
Provider Business Mailing Address
First Line : 1000 MAIN ST
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72202-3820
Country : US
Telephone Number : 501-244-1900
Fax Number :
Provider Business Practice Location Address
First Line : 1000 MAIN ST
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72202-3820
Country : US
Telephone Number : 501-244-1900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2023
Last Update Date : 08/10/2023

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Directions to “ CRYSTAL JANAI' GRAVES LCSW” Practice Location

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