Provider Demographics
NPI:1881876258
Name:GRAHAM, MARK F (EDD, LPC-S)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:F
Last Name:GRAHAM
Suffix:
Gender:
Credentials:EDD, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 SPRUCE DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-1024
Mailing Address - Country:US
Mailing Address - Phone:985-246-9315
Mailing Address - Fax:
Practice Address - Street 1:100 SOUTH TYLER ST.
Practice Address - Street 2:SUITE 7-A
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433
Practice Address - Country:US
Practice Address - Phone:985-893-4411
Practice Address - Fax:985-893-4411
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA383101YP2500X
LA514106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist