Individual
GRAHAM BACON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCPC
Contact information
Practice address
114 W PINE ST STE 3, MISSOULA, MT 59802-4222
(406) 481-6604
Mailing address
3930 CAVALIER CT, MISSOULA, MT 59801-8928
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
BBH-LCPC-LIC-71388
MT
Other
Enumeration date
02/06/2023
Last updated
06/20/2024
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