MEDICARE: KEISHA GRAHAM MSW, LCSW

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1063780500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEISHA GRAHAM MSW, LCSW

Provider Business Mailing Address
First Line	:	2620 S MARYLAND PKWY STE 14-199
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-8300
Country	:	US
Telephone Number	:	702-490-9009
Fax Number	:	866-737-6147

Provider Business Practice Location Address
First Line	:	2755 E DESERT INN RD STE 260
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-3690
Country	:	US
Telephone Number	:	702-490-9009
Fax Number	:	866-737-6147

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

Provider Enumeration Date	:	12/13/2011
Last Update Date	:	11/30/2024

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