Provider Demographics
NPI:1699923755
Name:GRAVES, BETH ANN (LPC)
Entity type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ANN
Last Name:GRAVES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 LENHART RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-9203
Mailing Address - Country:US
Mailing Address - Phone:217-698-7150
Mailing Address - Fax:217-698-7150
Practice Address - Street 1:1700 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:IL
Practice Address - Zip Code:62656-1047
Practice Address - Country:US
Practice Address - Phone:217-971-8423
Practice Address - Fax:217-732-7272
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2012-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.004683101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional