MEDICARE: KYRA SHAPIRO GRAHAM AMFT 138977

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	106S00000X	Behavior Technician
2	106H00000X	Marriage & Family Therapist	138977	CA

General Provider Information

NPI Number	:	1427572064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYRA SHAPIRO GRAHAM AMFT 138977

Provider Business Mailing Address
First Line	:	9012 FIR AVE
Second Line	:
City	:	CALIFORNIA CITY
State	:	CA
Zip	:	93505-2783
Country	:	US
Telephone Number	:	661-528-8892
Fax Number	:

Provider Business Practice Location Address
First Line	:	9012 FIR AVE
Second Line	:
City	:	CALIFORNIA CITY
State	:	CA
Zip	:	93505-2783
Country	:	US
Telephone Number	:	661-528-8892
Fax Number	:

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

Provider Enumeration Date	:	07/26/2017
Last Update Date	:	10/18/2024

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