Provider Demographics
NPI:1942704382
Name:GRAHAM, CHRIS
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:
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 1:200 6TH ST
Mailing Address - Street 2:
Mailing Address - City:GRUVER
Mailing Address - State:IA
Mailing Address - Zip Code:51334-8518
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 6TH ST
Practice Address - Street 2:
Practice Address - City:GRUVER
Practice Address - State:IA
Practice Address - Zip Code:51334-8518
Practice Address - Country:US
Practice Address - Phone:712-362-5231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor