Active NPI
Kassidy Graham, LPC
- Counselor
- Laramie, WY
National Provider Identifier
1851672042
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- LPC - 1267
- Practice address
- 4989 N 3Rd St
Laramie, WY 82072-9548 - Phone
- (307) 745-8997
- NPI assigned
- Sep 1, 2011
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 532 | WY | |
| Professional Counselor | 101YP2500X | LPC - 1267 | WY | |
| Counselor | 101Y00000X | LPC - 1267 | WY | Primary |
Addresses
Primary practice location
4989 N 3Rd St
Laramie, WY 82072-9548
Mailing address
1201 Downey St
Laramie, WY 82072-1845
Phone (307) 745-8997
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LPC - 1267 | Other | WY | STATE LICENSE |
| 532 | Other | WY | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC - 1267 | WY | MD | Counselor |
| 532 | WY | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1314835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1345766400000",
"number": "1851672042",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1201 DOWNEY ST",
"city": "LARAMIE",
"state": "WY",
"postal_code": "820721845",
"telephone_number": "307-745-8997"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4989 N 3RD ST",
"city": "LARAMIE",
"state": "WY",
"postal_code": "820729548",
"telephone_number": "307-745-8997"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAHAM",
"first_name": "KASSIDY",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-09-01",
"last_updated": "2012-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "WY",
"license": "532",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WY",
"license": "LPC - 1267",
"primary": false
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "WY",
"license": "LPC - 1267",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "LPC - 1267",
"state": "WY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "532",
"state": "WY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Laramie, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.