Ellen Anne Graham, LCSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LCS13618 Issued in CA

Practice address

1346 N Mulberry Ave
Upland, CA 91786-2739

Phone

(909) 996-6217

NPI assigned

Sep 17, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Ellen Anne Graham-Pottorff Other name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1158451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633392000000",
    "number": "1427155175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1346 N MULBERRY AVE",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917862739",
            "telephone_number": "909-996-6217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1346 N MULBERRY AVE",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917862739",
            "telephone_number": "909-996-6217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "ELLEN",
        "middle_name": "ANNE",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-17",
        "last_updated": "2021-10-05",
        "certification_date": "2021-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "LCS13618",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "9961 Sierra Ave",
            "city": "Fontana",
            "state": "CA",
            "country_code": "US",
            "postal_code": "923356720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ELLEN",
            "last_name": "GRAHAM-POTTORFF",
            "middle_name": "ANNE",
            "prefix": "MS.",
            "credential": "LCSW",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Bjorn Lars Gothberg
• Lien Governanti, PHARM.D.
• Trisna Gozali, NP-C
• Gracious Heart Hospice & Palliative Care , Inc.
• Susie J. Graff, MFT
• Joseph Graham
• Lindsey Caprice Graham
• Shirely Poblete Graham, PT
• Eric M Grammatikas, D.D.S.
• Kweku Grant-Acquah, M.D.

• Mental Health Counselor in Upland, CA
• Providers in Upland, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2021; 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.