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General NPI Number Information
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NPI Number | 1750411765
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Entity Type | Individual
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Provider Name | BERNADINE M. GRAHAM M.A.
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Gender | Female
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 233 E ERIE ST 601
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City | CHICAGO
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State | IL
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Zip | 60611-2926
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Country | US
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Telephone | 312-943-7166
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Fax |
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Provider Business Mailing Address
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Address Line | 825 PARK AVE
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City | RIVER FOREST
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State | IL
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Zip | 60305-1327
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Country | US
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Telephone | 708-771-8442
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Fax | 708-771-8442
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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 | IL
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