Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist |
NPI | 1164697157 |
---|---|
Provider Name | Mrs. Brianne Graves |
First Address | Jacksonville, FL 32277-0616 |
Second Address | Jacksonville, FL 32277-0616 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2008 |
Last Update Date | 29/04/2008 |