MEDICARE: MR. JOHN ALEXANDER ERIC GRAHAM PSYCHOLOGIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	301343	MN
2	103T00000X	Psychologist	LP2659	MN

General Provider Information

NPI Number	:	1023152667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN ALEXANDER ERIC GRAHAM PSYCHOLOGIST

Provider Business Mailing Address
First Line	:	485 HWY 71 N
Second Line	:
City	:	HINES
State	:	MN
Zip	:	56647-5798
Country	:	US
Telephone Number	:	218-586-4057
Fax Number	:

Provider Business Practice Location Address
First Line	:	403 4TH ST NW STE 110
Second Line	:
City	:	BEMIDJI
State	:	MN
Zip	:	56601-3155
Country	:	US
Telephone Number	:	218-586-4057
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	09/11/2025

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