Provider Demographics
NPI:1215489471
Name:GRAHAM, CHRISTOPHER (LPC)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:LPC
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 805
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-0805
Mailing Address - Country:US
Mailing Address - Phone:231-347-5511
Mailing Address - Fax:
Practice Address - Street 1:704 EMMET ST
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2910
Practice Address - Country:US
Practice Address - Phone:231-347-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-03
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401017257101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional