| Doctor Name: | JILL GRAVOIS |
| NPI Number: | 1053540575 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ASW |
| License Number: | 35575 |
| Business Practice Address: | 2640 Industry Way Ste. A Lynwood, CA - 902624284 |
| Business Phone Number: | 4242131150 |
| Business Fax Number: | 4242131158 |
| Mailing Address: | P.o. Box 4743, LONG BEACH |
| State: | CA |
| Postal Code: | 90804 |
| Phone Number: | 5627081068 |
| Fax Number: | |
| NPI Enumeration Date: | 07/06/2009 |
| NPI Last Update Date: | 02/19/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 35575 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |