MEDICARE: JOY ANNE GRAHAM LCPC

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	101YM0800X	Mental Health Counselor	57257	MT
2	101YP2500X	Professional Counselor	57257
3	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1447899133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOY ANNE GRAHAM LCPC

Provider Business Mailing Address
First Line	:	725 SW HIGGINS AVE STE D
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59803-1420
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	725 SW HIGGINS AVE STE D
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59803-1420
Country	:	US
Telephone Number	:	406-924-3445
Fax Number	:

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

Provider Enumeration Date	:	12/30/2019
Last Update Date	:	09/27/2023

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