Provider Demographics
NPI:1861745564
Name:MCGUIRE, GISELE GRAVES (PHD)
Entity type:Individual
Prefix:DR
First Name:GISELE
Middle Name:GRAVES
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:GISELE
Other - Middle Name:JEWEL
Other - Last Name:GRAVES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:7550 HIGHWAY 107
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-4645
Mailing Address - Country:US
Mailing Address - Phone:501-771-4442
Mailing Address - Fax:501-992-0138
Practice Address - Street 1:7550 HIGHWAY 107
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-4645
Practice Address - Country:US
Practice Address - Phone:501-771-4442
Practice Address - Fax:501-992-0138
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR79-39LPE-I103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist