Healthcare Provider Details

I. General information

NPI: 1932526100
Provider Name (Legal Business Name): KATIE GRAHAM MSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 04/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4339 WINSTON AVE
COVINGTON KY
41015-1739
US

IV. Provider business mailing address

4339 WINSTON AVE
COVINGTON KY
41015-1739
US

V. Phone/Fax

Practice location:
  • Phone: 859-835-2573
  • Fax:
Mailing address:
  • Phone: 859-835-2573
  • Fax: 859-727-6327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2013-041
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number130656
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: