MEDICARE: CHRISTY GRAHAM, LPC & ASSOCIATES LLC

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
2	101YP2500X	Professional Counselor	16563	TX

General Provider Information

NPI Number	:	1710307509
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTY GRAHAM, LPC & ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	1402 N CORINTH ST STE 116
Second Line	:
City	:	CORINTH
State	:	TX
Zip	:	76208-5445
Country	:	US
Telephone Number	:	940-597-9635
Fax Number	:

Provider Business Practice Location Address
First Line	:	1402 N CORINTH ST STE 116
Second Line	:
City	:	CORINTH
State	:	TX
Zip	:	76208-5445
Country	:	US
Telephone Number	:	940-597-9635
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST, PRESIDENT
Name	:	MRS. CHRISTY GRAHAM
Credential	:	LPC
Telephone Number	:	940-597-9635

Provider Enumeration Date	:	04/21/2014
Last Update Date	:	04/21/2014

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