Provider Demographics
NPI:1265400949
Name:GRAHAM, MATTHEW (LMHC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 N HARRISON ST
Mailing Address - Street 2:OTIS R. BOWEN CENTER
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-3163
Mailing Address - Country:US
Mailing Address - Phone:574-267-7169
Mailing Address - Fax:574-269-3995
Practice Address - Street 1:5233 S 50 E
Practice Address - Street 2:WHITE'S INSTITUTE
Practice Address - City:WABASH
Practice Address - State:IN
Practice Address - Zip Code:46992-8011
Practice Address - Country:US
Practice Address - Phone:260-563-1158
Practice Address - Fax:260-563-8975
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001757A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health