Provider Demographics
NPI:1821554072
Name:GRAHAM, KARA (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 E STATE ROAD 14
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:46975-9134
Mailing Address - Country:US
Mailing Address - Phone:574-355-0770
Mailing Address - Fax:
Practice Address - Street 1:2005 E STATE ROAD 14
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:IN
Practice Address - Zip Code:46975-9134
Practice Address - Country:US
Practice Address - Phone:574-355-0770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-17-32719106S00000X
IN1-19-34665103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician