Provider Demographics
NPI:1912133554
Name:GRAHAM, JOANNE L (MA, LPC)
Entity type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:L
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 MCBRIDE POINTE DR
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63011-1757
Mailing Address - Country:US
Mailing Address - Phone:314-628-9393
Mailing Address - Fax:
Practice Address - Street 1:14226 LADUE RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3344
Practice Address - Country:US
Practice Address - Phone:314-540-4340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002020628101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health