Individual provider Active NPI

Anthony Graham, LPC

  • Counselor
  • Mentor, OH
National Provider Identifier
1730629445
Registry record updated Jan 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
License
C.1500356 Issued in OH
Practice address
7232 Justin Way
Mentor, OH 44060-4881
Phone
(440) 578-8200
NPI assigned
Feb 28, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X C.1500356 OH
Counselor 101Y00000X C.1500356 OH Primary

Addresses

Primary practice location

7232 Justin Way
Mentor, OH 44060-4881

Mailing address

7232 Justin Way
Mentor, OH 44060-4881
Phone (440) 578-8200

Other identifiers 1

IdentifierTypeStateIssuer
0270615MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240109002041 OH Practitioner - Mental Health Counselor 5092166553 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
C.1500356OHMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Signature Health, Inc. Current Accepting new patients
Signature Health Inc CurrentSince Jan 1, 2024 Accepting new patients
Signature Health, Inc CurrentSince Jan 1, 2024 Accepting new patients

Locations

21100 Southgate Park Blvd
Maple Heights, OH 44137
Phone (216) 663-6100

7232 Justin Way
Mentor, OH 44060
Phone (440) 488-2855

38882 Mentor Ave
Willoughby, OH 44094

38876 Mentor Ave
Willoughby, OH 44094
Phone (440) 954-3333

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1488240000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611619200000",
    "number": "1730629445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7232 JUSTIN WAY",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440604881",
            "telephone_number": "440-578-8200",
            "fax_number": "216-431-4151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7232 JUSTIN WAY",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440604881",
            "telephone_number": "440-578-8200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "ANTHONY",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-02-28",
        "last_updated": "2021-01-26",
        "certification_date": "2021-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": "C.1500356",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "OH",
            "license": "C.1500356",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0270615",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mentor, OH

Sources for this page

Verify at the official NPI Registry.