Provider Demographics
NPI:1073112702
Name:GRAGES, CLARISSE A (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CLARISSE
Middle Name:A
Last Name:GRAGES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:MONTEVIDEO
Mailing Address - State:MN
Mailing Address - Zip Code:56265-2246
Mailing Address - Country:US
Mailing Address - Phone:830-237-7335
Mailing Address - Fax:
Practice Address - Street 1:724 N TEJON ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1012
Practice Address - Country:US
Practice Address - Phone:710-227-7745
Practice Address - Fax:719-227-7743
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099268901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical