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General NPI Number Information
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NPI Number | 1982220851
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Entity Type | Organization
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Legal Business Name | SUSANNE GRAHAM
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Dates
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Enumeration Date | 06/17/2020
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Last Update Date | 06/20/2020
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Provider Practice Location Address
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Address Line | 11029 SPRING HILL DR
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City | SPRING HILL
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State | FL
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Zip | 34608-5049
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Country | US
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Telephone | 352-345-9267
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Fax | 352-592-7742
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Provider Business Mailing Address
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Address Line | 6509 OREGON CHICKADEE RD
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City | WEEKI WACHEE
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State | FL
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Zip | 34613-8353
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Country | US
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Telephone | 352-345-9267
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Fax |
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Authorized Official
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Title or Position | LICENSED MENTAL HEALTH COUNSELOR
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Name | SUSANNE L GRAHAM
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Credential | LMHC
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Telephone | 352-345-9267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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