Provider Demographics
NPI:1699947937
Name:GRAVESMILL, JOHANNA LOUISE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JOHANNA
Middle Name:LOUISE
Last Name:GRAVESMILL
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11907 RIBBON FALLS DR
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-3363
Mailing Address - Country:US
Mailing Address - Phone:512-773-8373
Mailing Address - Fax:
Practice Address - Street 1:5629 FM 1960 RD W STE 218
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-4215
Practice Address - Country:US
Practice Address - Phone:832-232-3332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX190511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1780498204OtherORGANIZATION NPI