Provider Demographics
NPI:1164016705
Name:GRAHAM, AARON G
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:G
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8250 E HARVARD AVE APT 7302
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-2218
Mailing Address - Country:US
Mailing Address - Phone:804-715-7665
Mailing Address - Fax:
Practice Address - Street 1:820 16TH ST STE 420
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-3222
Practice Address - Country:US
Practice Address - Phone:615-249-4471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor