Individual
SAMANTHA GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
180 10TH ST SE STE 201, LE MARS, IA 51031-2557
(712) 546-4624
Mailing address
PO BOX 70, LE MARS, IA 51031-0070
(712) 546-4624
(712) 546-9395
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
088121
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1184706566
—
IA
05
—
1497930572
—
IA
Enumeration date
07/27/2017
Last updated
02/08/2024
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