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NPI Code Detail

MEDICARE: CHRIS GRAHAM LPC

MEDICARE: CHRIS GRAHAM LPC
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
1101YP2500XProfessional CounselorLPC-4976ID

General Provider Information

NPI Number : 1275934549
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRIS GRAHAM LPC
Provider Business Mailing Address
First Line : 849 E FAIRVIEW AVE
Second Line :
City : MERIDIAN
State : ID
Zip : 83642-1806
Country : US
Telephone Number : 208-860-9868
Fax Number :
Provider Business Practice Location Address
First Line : 849 E FAIRVIEW AVE
Second Line :
City : MERIDIAN
State : ID
Zip : 83642-1806
Country : US
Telephone Number : 208-860-9868
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2014
Last Update Date : 09/05/2014

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Directions to “ CHRIS GRAHAM LPC” Practice Location

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