=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588738579
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZABETH JO GRAHAM LCPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5911 W 84TH ST
-----------------------------------------------------
City | OVERLAND PARK
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66207-1633
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-381-4777
-----------------------------------------------------
Fax | 913-383-1452
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3965 W 83RD ST PMB 333
-----------------------------------------------------
City | PRAIRIE VILLAGE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66208-5308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-381-4777
-----------------------------------------------------
Fax | 913-383-1452
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 0135
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 0135
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------