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General NPI Number Information
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NPI Number | 1770350605
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Entity Type | Individual
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Provider Name | BRAD GRAHAM M.ED., LPC
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Gender | Male
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Dates
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Enumeration Date | 12/11/2023
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Last Update Date | 12/11/2023
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Provider Practice Location Address
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Address Line | 3985 WONDERLAND HILL AVE # 102
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City | BOULDER
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State | CO
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Zip | 80304-1038
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Country | US
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Telephone | 720-704-3344
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Fax |
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Provider Business Mailing Address
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Address Line | 2325 FOREST AVE
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City | BOULDER
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State | CO
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Zip | 80304-2811
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Country | US
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Telephone | 303-898-3626
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC.0013680
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License Number State | CO
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