Provider Demographics
NPI:1902059249
Name:GRAVES, CHERYL R (MSW, LCSW, LSCSW)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:R
Last Name:GRAVES
Suffix:
Gender:F
Credentials:MSW, LCSW, LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 JOHNSON DR STE 210
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66205-2920
Mailing Address - Country:US
Mailing Address - Phone:913-313-2044
Mailing Address - Fax:913-499-7045
Practice Address - Street 1:5201 JOHNSON DR STE 210
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66205-2920
Practice Address - Country:US
Practice Address - Phone:913-313-2044
Practice Address - Fax:913-499-7045
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-30
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20070331661041C0700X, 1041C0700X
KS39631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1942783535OtherSUNFLOWER PSYCHOLOGICAL LLC NPI