Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 859 | KS |
N | 103T00000X | Psychologist | 859 | KS |
N | 103TA0700X | Adult Development & Aging Psychologist | 859 | KS |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 859 | KS |
N | 103G00000X | Clinical Psychologist | 859 | KS |
N | 103TC0700X | Clinical Psychologist | 859 | KS |
N | 103TF0200X | Forensic Psychologist | 859 | KS |
N | 103TP0814X | Psychoanalysis | 859 | KS |
N | 103TP2701X | Group Psychotherapist | 859 | KS |
NPI | 1215092721 |
---|---|
Provider Name | Dr. Peter Graham |
First Address | Lawrence, KS 66044-2823 |
Second Address | Lawrence, KS 66044-2823 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R86082 | (02) | KS |