Graves, Kenneth Jerome

Graves, Kenneth Jerome is an sole proprietor health care provider with primary practice located at 1005 W Jefferson Blvd Suite 205, Dallas TX 75208-5087. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical Child & Adolescent, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Graves, Kenneth Jerome can be contacted via phone (214) 916-4025.

Contact Information

Primary practice address
1005 W Jefferson Blvd Suite 205 Dallas TX 75208-5087
Phone: (214) 916-4025
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical Child & Adolescent 103TC2200X 30557 Texas
Behavioral Health & Social Service Providers / Clinical 103TC0700X 30557 Texas

Profile Details

NPI number 1275689416
LBN Legal business name Graves, Kenneth Jerome
Credentials PH.D.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 27th, 2007
Last updated Apr 16th, 2018 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1275689416 NPPES
Texas MEDICAID 0962334-01

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