Basic Information
| Provider Information | |||||||||
| NPI: | 1568846707 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GRAVEN AND ASSOCIATES, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2257 | ||||||||
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| City: | CHESTERTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463040357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2199268320 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8007 LYNDON CENTRE WAY, SUITE # 101 | ||||||||
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| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026908024 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2015 | ||||||||
| LastUpdateDate: | 04/05/2019 | ||||||||
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| AuthorizedOfficialLastName: | GRAVEN | ||||||||
| AuthorizedOfficialFirstName: | JACQUELYN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2199268320 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PSYD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
No ID Information.