Provider Demographics
NPI:1376165530
Name:GRAHAM, KIRSTEN LEIGH (PHD)
Entity Type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:LEIGH
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 W UNIVERSITY BLVDGENERAL CLASSROOMS 308-O
Mailing Address - Street 2:GENERAL CLASSROOMS 308-O
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720
Mailing Address - Country:US
Mailing Address - Phone:435-865-8446
Mailing Address - Fax:435-865-8289
Practice Address - Street 1:351 W UNIVERSITY BLVDGENERAL CLASSROOMS 308-O
Practice Address - Street 2:GENERAL CLASSROOMS 308-O
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720
Practice Address - Country:US
Practice Address - Phone:435-277-0285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11486546-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical