MEDICARE: LAUREN GRAHAM MA, CIT

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1427518810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN GRAHAM MA, CIT

Provider Business Mailing Address
First Line	:	3610 N CHOUTEAU TRFY APT A
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64117-3105
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	888 HAINES STE 230
Second Line	:
City	:	LIBERTY
State	:	MO
Zip	:	64068-1008
Country	:	US
Telephone Number	:	816-373-9240
Fax Number	:

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

Provider Enumeration Date	:	03/21/2019
Last Update Date	:	03/21/2019

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