Provider Demographics
NPI:1386808632
Name:GRAVETT, RUBY DENISE (CMHC)
Entity type:Individual
Prefix:
First Name:RUBY
Middle Name:DENISE
Last Name:GRAVETT
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:R DENISE
Other - Middle Name:
Other - Last Name:GRAVETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:327 S 500 E
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2525
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:327 S 500 E
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2525
Practice Address - Country:US
Practice Address - Phone:801-669-4414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6321303-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional