Provider Demographics
NPI:1215129911
Name:GRAVES, STACY LEE (LMT)
Entity type:Individual
Prefix:MR
First Name:STACY
Middle Name:LEE
Last Name:GRAVES
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2666 NEWCASLE ST.
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404
Mailing Address - Country:US
Mailing Address - Phone:541-914-1698
Mailing Address - Fax:
Practice Address - Street 1:1524 WILLAMETTE ST
Practice Address - Street 2:SUITE 202
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4093
Practice Address - Country:US
Practice Address - Phone:541-914-1698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10714175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath