Provider Demographics
NPI:1114410818
Name:GRAHAM, KELSEY MICHELLE (LMFT)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:MICHELLE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:MICHELLE
Other - Last Name:KOCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:8512 E KNOX AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99212-2312
Mailing Address - Country:US
Mailing Address - Phone:509-951-4330
Mailing Address - Fax:509-808-2164
Practice Address - Street 1:8512 E KNOX AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99212-2312
Practice Address - Country:US
Practice Address - Phone:509-951-4330
Practice Address - Fax:509-808-2164
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-08
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF61084650106H00000X
WAMG60790700106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2163486Medicaid