Provider Demographics
NPI:1306081203
Name:GRAVES, LOWELL B (GAMBLING COUNSELOR)
Entity type:Individual
Prefix:MR
First Name:LOWELL
Middle Name:B
Last Name:GRAVES
Suffix:
Gender:M
Credentials:GAMBLING COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4141
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-0141
Mailing Address - Country:US
Mailing Address - Phone:360-352-1052
Mailing Address - Fax:360-352-0956
Practice Address - Street 1:1610 BISHOP RD SW
Practice Address - Street 2:SUITE 105
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-7303
Practice Address - Country:US
Practice Address - Phone:360-352-1052
Practice Address - Fax:360-352-0956
Is Sole Proprietor?:No
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC 00054502101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACP 000057468OtherCHEMICAL DEPENDENCY PROFESSIONAL
519OtherNATIONALLY CERTIFIED GAMBLING COUNSELOR