Provider Demographics
NPI:1487112421
Name:GRAVES, MICHELLE LYNN (MA ED)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:GRAVES
Suffix:
Gender:F
Credentials:MA ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 VENTURE CIR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-1604
Mailing Address - Country:US
Mailing Address - Phone:731-435-9679
Mailing Address - Fax:
Practice Address - Street 1:71 CHARNELL ST
Practice Address - Street 2:
Practice Address - City:BETHEL SPRINGS
Practice Address - State:TN
Practice Address - Zip Code:38315-3523
Practice Address - Country:US
Practice Address - Phone:731-435-9679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker