Individual
DR. KENNETH JEROME GRAVES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1005 W JEFFERSON BLVD, SUITE 205, DALLAS, TX 75208-5087
(214) 916-4025
Mailing address
3551 ROGER BROOKE DR, SAN ANTONIO, TX 78234-4504
(210) 916-6299
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
30557
TX
103TC2200X
Clinical Child & Adolescent Psychologist
30557
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0962334-01
—
TX
Enumeration date
01/27/2007
Last updated
04/16/2018
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