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General NPI Number Information
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NPI Number | 1508545047
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Entity Type | Individual
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Provider Name | GRAHAM CLAYTON HUSICK PSYD
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Gender | Male
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Dates
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Enumeration Date | 07/12/2023
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Last Update Date | 08/22/2025
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Provider Practice Location Address
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Address Line | 1324 E SHERMAN AVE
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City | COEUR D ALENE
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State | ID
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Zip | 83814-4042
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Country | US
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Telephone | 208-244-0290
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Fax |
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Provider Business Mailing Address
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Address Line | 1433 S FAIRMONT LOOP
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City | COEUR D ALENE
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State | ID
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Zip | 83814-8930
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Country | US
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Telephone | 425-698-9382
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3671779
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License Number State | ID
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