Individual
KASSIDY GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
4989 N 3RD ST, LARAMIE, WY 82072-9548
(307) 745-8997
Mailing address
1201 DOWNEY ST, LARAMIE, WY 82072-1845
(307) 745-8997
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
532
WY
101Y00000X
Counselor
Primary
LPC - 1267
WY
101YP2500X
Professional Counselor
LPC - 1267
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
532
STATE LICENSE
WY
01
—
LPC - 1267
STATE LICENSE
WY
Enumeration date
09/01/2011
Last updated
08/24/2012
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