Active NPI
Stephen Gravois, LPC
- Professional Counselor
- Fort Worth, TX
National Provider Identifier
1265254148
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 89717
- Practice address
- 451 University Dr Ste 201
Fort Worth, TX 76107-2130 - Phone
- (682) 233-0443
- NPI assigned
- Oct 30, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 89717 | TX | Primary |
Addresses
Primary practice location
451 University Dr Ste 201
Fort Worth, TX 76107-2130
Mailing address
451 University Dr Ste 201
Fort Worth, TX 76107-2130
Phone (682) 233-0443
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Nov 1, 2024 through Nov 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 89717 | TX | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1730246400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730246400000",
"number": "1265254148",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "451 UNIVERSITY DR STE 201",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761072130",
"telephone_number": "682-233-0443"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "451 UNIVERSITY DR STE 201",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761072130",
"telephone_number": "682-233-0443"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAVOIS",
"first_name": "STEPHEN",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-10-30",
"last_updated": "2024-10-30",
"certification_date": "2024-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "89717",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.