Othadell NA Graham, LISW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

0002629 Issued in OH

Practice address

24300 Chagrin Blvd
303
Beachwood, OH 44122-5639

Phone

(216) 556-0696

Fax

(216) 932-3091

NPI assigned

Oct 2, 2009

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1254441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1254441600000",
    "number": "1336474709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24300 CHAGRIN BLVD",
            "address_2": "303",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "441225639",
            "telephone_number": "216-556-0696",
            "fax_number": "216-932-3091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24300 CHAGRIN BLVD",
            "address_2": "303",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "441225639",
            "telephone_number": "216-556-0696",
            "fax_number": "216-932-3091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "OTHADELL",
        "middle_name": "NA",
        "name_prefix": "Ms.",
        "credential": "LISW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-10-02",
        "last_updated": "2009-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "0002629",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Lynn Gould, LPCC-S
• Deborah Jean Gould, MD
• Holly Gower
• Nora O'Reilly Grabowski, MSN, RN, FNP-C
• Kamron M Grady
• Robert William Graham, P T
• Samantha Lee Graham, LSW
• Zion A Graham
• Gail L Grandstaff, PT
• David Granoff, PSY.D.

• Mental Health Counselor in Beachwood, OH
• Providers in Beachwood, OH by specialty
• Mental Health Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.