MEDICARE: MRS. LORI F. GRAHAM LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	1249C	AR

General Provider Information

NPI Number	:	1205850104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LORI F. GRAHAM LCSW

Provider Business Mailing Address
First Line	:	1920 MAIN ST
Second Line	:	SUITE 225
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72114-2872
Country	:	US
Telephone Number	:	501-952-9977
Fax Number	:	501-771-2420

Provider Business Practice Location Address
First Line	:	1920 MAIN ST
Second Line	:	SUITE 225
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72114-2872
Country	:	US
Telephone Number	:	501-952-9977
Fax Number	:	501-771-2420

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/08/2013

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