| Doctor Name: | MR. KENNETH GRAVES |
| NPI Number: | 1114304920 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LMFT |
| License Number: | 84621 |
| Business Practice Address: | 11110 Los Alamitos Blvd 215 Los Alamitos, CA - 907203602 |
| Business Phone Number: | 7142476316 |
| Business Fax Number: | |
| Mailing Address: | 11110 Los Alamitos Blvd, 215 LOS ALAMITOS |
| State: | CA |
| Postal Code: | 907203602 |
| Phone Number: | 7142476316 |
| Fax Number: | |
| NPI Enumeration Date: | 04/30/2015 |
| NPI Last Update Date: | 04/30/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 84621 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |