Provider Demographics
NPI:1013229483
Name:GRAHAM, KELLI (LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 SOUTHRIDGE CT
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-4306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1240 SOUTHRIDGE CT
Practice Address - Street 2:SUITE 105
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-4306
Practice Address - Country:US
Practice Address - Phone:817-614-1488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61306101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional