MEDICARE: GRAHAM AND ASSOCIATES

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	103TC0700X	Clinical Psychologist
2	103TC1900X	Counseling Psychologist

General Provider Information

NPI Number	:	1770247181
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAHAM AND ASSOCIATES

Provider Business Mailing Address
First Line	:	1704 CENTRAL AVE
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-5326
Country	:	US
Telephone Number	:	812-799-0074
Fax Number	:

Provider Business Practice Location Address
First Line	:	1704 CENTRAL AVE
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-5326
Country	:	US
Telephone Number	:	812-799-0074
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	BRIAN SCOTT GRAHAM
Credential	:
Telephone Number	:	812-799-0074

Provider Enumeration Date	:	10/22/2021
Last Update Date	:	11/11/2021

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