Active NPI
Shelly Eyre Graham, PHD
- Clinical Psychologist
- Powell, WY
National Provider Identifier
1720853963
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 771
- Practice address
- 223 E 5TH St
Powell, WY 82435-1906 - Phone
- (831) 334-3370
- NPI assigned
- Nov 17, 2023
- Last updated
- Nov 17, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 771 | WY | Primary |
| Clinical Psychologist | 103TC0700X | 22269 | CA |
Addresses
Primary practice location
223 E 5TH St
Powell, WY 82435-1906
Mailing address
223 E 5TH St
Powell, WY 82435-1906
Phone (831) 334-3370
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 28, 2025 through Mar 28, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 771 | WY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1700179200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1700179200000",
"number": "1720853963",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "223 E 5TH ST",
"city": "POWELL",
"state": "WY",
"postal_code": "824351906",
"telephone_number": "831-334-3370"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "223 E 5TH ST",
"city": "POWELL",
"state": "WY",
"postal_code": "824351906",
"telephone_number": "831-334-3370"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAHAM",
"first_name": "SHELLY",
"middle_name": "EYRE",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-11-17",
"last_updated": "2023-11-17",
"certification_date": "2023-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WY",
"license": "771",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "22269",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Powell, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.