Individual
JEFFREY GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, LCPC
Contact information
Practice address
706 OGLESBY AVE STE 300, NORMAL, IL 61761-4616
(309) 212-3606
Mailing address
706 OGLESBY AVE STE 300, NORMAL, IL 61761-4616
(309) 212-3606
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
180013821
IL
Other
Enumeration date
09/22/2020
Last updated
01/04/2022
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