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General NPI Number Information
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NPI Number | 1770247181
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Entity Type | Organization
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Legal Business Name | GRAHAM AND ASSOCIATES
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Dates
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Enumeration Date | 10/22/2021
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Last Update Date | 11/11/2021
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Provider Practice Location 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 |
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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 |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | BRIAN SCOTT GRAHAM
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Credential |
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Telephone | 812-799-0074
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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