Provider Demographics
NPI:1629465646
Name:GRAHAM, CYNTHIA ELAINE (LPCP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ELAINE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LPCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 COOK AVE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-5806
Mailing Address - Country:US
Mailing Address - Phone:406-281-6221
Mailing Address - Fax:406-254-1287
Practice Address - Street 1:1044 COOK AVE
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-5806
Practice Address - Country:US
Practice Address - Phone:406-281-6221
Practice Address - Fax:406-254-1287
Is Sole Proprietor?:No
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1530101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health