Provider Demographics
NPI:1093179244
Name:GRAHAM, SCARLET (LPC)
Entity Type:Individual
Prefix:
First Name:SCARLET
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SCARLET
Other - Middle Name:
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:1435 ASH ST.
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034
Mailing Address - Country:US
Mailing Address - Phone:503-946-9871
Mailing Address - Fax:888-710-4511
Practice Address - Street 1:1435 ASH ST
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-4705
Practice Address - Country:US
Practice Address - Phone:503-946-9871
Practice Address - Fax:888-710-4511
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-13
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5077101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional