Provider Demographics
NPI:1962826180
Name:ELIASON, GRAFTON TODD (LPC)
Entity Type:Individual
Prefix:DR
First Name:GRAFTON
Middle Name:TODD
Last Name:ELIASON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 BRIARWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MT LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:15228-2552
Mailing Address - Country:US
Mailing Address - Phone:862-266-4021
Mailing Address - Fax:
Practice Address - Street 1:616 BRIARWOOD AVE
Practice Address - Street 2:
Practice Address - City:MT LEBANON
Practice Address - State:PA
Practice Address - Zip Code:15228-2552
Practice Address - Country:US
Practice Address - Phone:862-266-4021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC001153101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPC001153OtherLPC