Individual
MEDJINE DESGRAVES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PLMHP
Contact information
Practice address
5217 S 28TH ST, OMAHA, NE 68107-3402
(402) 715-5449
(402) 715-5452
Mailing address
5217 S 28TH ST, OMAHA, NE 68107-3402
(402) 715-5449
(402) 715-5452
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
12187
NE
101YM0800X
Mental Health Counselor
Primary
3061
NE
Other
Enumeration date
06/24/2020
Last updated
05/31/2024
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