Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP2500X | Professional Counselor | ||
N | 103G00000X | Clinical Psychologist | 20043452A | IN |
N | 103TC0700X | Clinical Psychologist | 20043452A | IN |
Y | 103TC1900X | Counseling Psychologist | 20043452A | IN |
NPI | 1053772038 |
---|---|
Provider Name | Dr. Myriam Levesque Graham |
First Address | Columbus, IN 47201-9661 |
Second Address | Seymour, IN 47274-1723 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2016 |
Last Update Date | 28/10/2021 |