MEDICARE: HOLLY 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
1	101YM0800X	Mental Health Counselor	LPC-8024	ID

General Provider Information

NPI Number	:	1588258677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY GRAHAM LPC

Provider Business Mailing Address
First Line	:	1686 MERIDIAN RD
Second Line	:
City	:	CRAIGMONT
State	:	ID
Zip	:	83523-5056
Country	:	US
Telephone Number	:	208-921-3920
Fax Number	:

Provider Business Practice Location Address
First Line	:	404 MAIN ST STE A
Second Line	:
City	:	COTTONWOOD
State	:	ID
Zip	:	83522-5270
Country	:	US
Telephone Number	:	208-921-3920
Fax Number	:

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

Provider Enumeration Date	:	03/01/2021
Last Update Date	:	02/05/2026

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Directions to “ HOLLY GRAHAM LPC” Practice Location

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