MEDICARE: TIFFANY GRAVES

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	101YM0800X	Mental Health Counselor	E.2102560	OH

General Provider Information

NPI Number	:	1881225720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY GRAVES

Provider Business Mailing Address
First Line	:	7519 FLINTSHIRE DR
Second Line	:
City	:	ALEXANDRIA
State	:	KY
Zip	:	41001-1438
Country	:	US
Telephone Number	:	859-805-1629
Fax Number	:

Provider Business Practice Location Address
First Line	:	2021 AUBURN AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-3024
Country	:	US
Telephone Number	:	859-878-2254
Fax Number	:

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

Provider Enumeration Date	:	01/29/2020
Last Update Date	:	02/07/2024

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Directions to “ TIFFANY GRAVES ” Practice Location

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