Individual
MR. TARRANT LAJOHN GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
3812 NINOCK ST, SHREVEPORT, LA 71109-4424
(318) 573-1972
Mailing address
3812 NINOCK ST, SHREVEPORT, LA 71109-4424
(318) 573-1972
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3883
LA
Other
Enumeration date
10/08/2010
Last updated
10/08/2010
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