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General NPI Number Information
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NPI Number | 1831680636
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Entity Type | Organization
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Legal Business Name | LAUREN GRAHAM LLC
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Dates
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Enumeration Date | 05/29/2018
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Last Update Date | 05/29/2018
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Provider Practice Location Address
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Address Line | 323 N DIVISION ST
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City | POWELL
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State | WY
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Zip | 82435-2207
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Country | US
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Telephone | 307-250-0645
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Fax | 888-247-7592
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Provider Business Mailing Address
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Address Line | PO BOX 270
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City | POWELL
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State | WY
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Zip | 82435-0270
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Country | US
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Telephone | 307-250-0645
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Fax | 888-247-7592
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Authorized Official
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Title or Position | OWNER
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Name | LAUREN ALINE GRAHAM
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Credential | LCSW
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Telephone | 307-250-0645
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | LCSW-838
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-838
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License Number State | WY
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