Provider Demographics
NPI:1396505129
Name:GRAVES, MARY ELIZABETH (LPC, RPT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:GRAVES
Suffix:
Gender:F
Credentials:LPC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1828 E SE LOOP 323 STE 306
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-8314
Mailing Address - Country:US
Mailing Address - Phone:903-952-3757
Mailing Address - Fax:
Practice Address - Street 1:1828 E SE LOOP 323 STE 306
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-8314
Practice Address - Country:US
Practice Address - Phone:903-952-3757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85381101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional