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General NPI Number Information
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NPI Number | 1053772038
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Entity Type | Individual
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Provider Name | MYRIAM LEVESQUE GRAHAM PH.D.
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Gender | Female
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Dates
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Enumeration Date | 03/17/2016
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Last Update Date | 08/15/2022
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Provider Practice Location Address
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Address Line | 322 DUPONT DR
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City | SEYMOUR
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State | IN
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Zip | 47274-1723
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Country | US
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Telephone | 812-523-0386
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Fax | 812-523-8416
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Provider Business Mailing Address
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Address Line | 1704 CENTRAL AVE
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City | COLUMBUS
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State | IN
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Zip | 47201-5326
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Country | US
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Telephone | 812-799-0074
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Fax | 812-799-0319
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 20043452A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 20043452A
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License Number State | IN
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