Provider Information for 1679736045
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BETHANY GRAHAM LCSW
Sex: Female
NPI: 1679736045
Last Updated: 2019-03-19
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||||||
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| NPI | 1679736045 | ||||||||||||||||
| Enumeration Date | 2008-07-07 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | NO | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 118 W UNION ST MUNFORDVILLE, KY 42765-8911 United States Phone: | Fax: | ||||||||||||||||
| Primary Practice Address | 1311 N DIXIE AVE ELIZABETHTOWN, KY 42701-2621 United States Phone: 270-769-1311 | Fax: | ||||||||||||||||
| Secondary Practice Address(es) | 118 W UNION ST | ||||||||||||||||
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