Provider Demographics
NPI:1366755449
Name:GRAVETTI INC
Entity type:Organization
Organization Name:GRAVETTI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JON
Authorized Official - Last Name:GRAVETT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:435-610-1893
Mailing Address - Street 1:53 S 700 E
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-3128
Mailing Address - Country:US
Mailing Address - Phone:435-610-1896
Mailing Address - Fax:
Practice Address - Street 1:53 S 700 E
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-3128
Practice Address - Country:US
Practice Address - Phone:435-610-1896
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-19
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7014686-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty