Provider Demographics
NPI:1710526132
Name:GRAHAM, TIM (MA, LPC, CHWC)
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:MA, LPC, CHWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7140 N HIGH ST STE 250
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-2330
Mailing Address - Country:US
Mailing Address - Phone:614-591-8528
Mailing Address - Fax:
Practice Address - Street 1:7140 N HIGH ST STE 250
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2330
Practice Address - Country:US
Practice Address - Phone:614-591-8528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-02
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1902348101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor