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General NPI Number Information
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NPI Number | 1376343590
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Entity Type | Individual
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Provider Name | KELLIE GRAHAM PPS
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Gender |
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Dates
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Enumeration Date | 03/17/2025
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 1711 MISSION DR
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City | ANTIOCH
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State | CA
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Zip | 94509-4599
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Country | US
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Telephone | 925-779-7435
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Fax |
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Provider Business Mailing Address
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Address Line | 1711 MISSION DR
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City | ANTIOCH
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State | CA
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Zip | 94509-4599
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Country | US
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Telephone | 925-779-7435
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Fax |
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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 | 101YS0200X
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Taxonomy Name | School Counselor
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License Number |
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License Number State | CA
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