Individual
BETHANY GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1311 N DIXIE AVE, ELIZABETHTOWN, KY 42701-2621
(270) 769-1311
Mailing address
118 W UNION ST, MUNFORDVILLE, KY 42765-8911
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
3562
KY
104100000X
Social Worker
5210
KY
1041C0700X
Clinical Social Worker
3562
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100308470
—
KY
Enumeration date
07/07/2008
Last updated
03/19/2019
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