Provider Demographics
NPI:1528455979
Name:SANCHEZ-GRAVES, JUAN LUIS
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:LUIS
Last Name:SANCHEZ-GRAVES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 NW 123RD AVE.
Mailing Address - Street 2:19
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229
Mailing Address - Country:US
Mailing Address - Phone:971-217-0090
Mailing Address - Fax:
Practice Address - Street 1:1075 NW 123RD AVE
Practice Address - Street 2:19
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-5677
Practice Address - Country:US
Practice Address - Phone:971-217-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health