Provider Demographics
NPI:1396961835
Name:GRAHAM, LAUREN ALINE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:ALINE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 270
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435
Mailing Address - Country:US
Mailing Address - Phone:307-250-0645
Mailing Address - Fax:907-842-5174
Practice Address - Street 1:152 N. ABSAROKA ST. SUITE C
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-2207
Practice Address - Country:US
Practice Address - Phone:307-250-0645
Practice Address - Fax:307-247-7592
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1015LCSW1041C0700X
1041C0700X
WYLCSW-8381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical