Active NPI
Eliot Graham
- Mental Health Counselor
- Missoula, MT
National Provider Identifier
1720758998
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 63588
- Practice address
- 32 Campus Dr
Missoula, MT 59801 - Phone
- (406) 544-5694
- NPI assigned
- Sep 17, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 63588 | MT | Primary |
Addresses
Primary practice location
32 Campus Dr
Missoula, MT 59801
Mailing address
2230 N Reserve St Ste 300
Missoula, MT 59808-1364
Phone (406) 544-5694
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240111001977 | MT | Practitioner - Mental Health Counselor | 1456702760 | Practice locations: Missoula, MT |
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
Missoula, MT 59803
Phone (406) 544-5694
5105 Mainview Dr
Missoula, MT 59803-3121
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 63588 | MT | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1631836800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701302400000",
"number": "1720758998",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2230 N RESERVE ST STE 300",
"city": "MISSOULA",
"state": "MT",
"postal_code": "598081364",
"telephone_number": "406-544-5694"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "32 CAMPUS DR",
"city": "MISSOULA",
"state": "MT",
"postal_code": "59801",
"telephone_number": "406-544-5694"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAHAM",
"first_name": "ELIOT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-09-17",
"last_updated": "2023-11-30",
"certification_date": "2023-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MT",
"license": "63588",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Missoula, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.