Provider Demographics
NPI:1124681648
Name:GRAVES, NICI (LCSW)
Entity type:Individual
Prefix:
First Name:NICI
Middle Name:
Last Name:GRAVES
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 1:120 N BOULEVARD ST
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-3013
Mailing Address - Country:US
Mailing Address - Phone:970-641-4254
Mailing Address - Fax:
Practice Address - Street 1:120 N BOULEVARD ST
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-3013
Practice Address - Country:US
Practice Address - Phone:970-641-4254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-19
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLSW.0009921636104100000X
COCSW.099264461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker