SHONTAE L GRAHAM
Counselor

Address: 4261 San Pedro Pl, Los Angeles, CA 90011-2917

SHONTAE L GRAHAM (NPI# 1780177428) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1780177428
Entity Type Individual
Full Name SHONTAE L GRAHAM
Gender Female
Credential CC, MSP
Practice Address 4261 San Pedro Pl
Los Angeles
CA 90011-2917
Practice Telephone 3107706749
Mailing Address 4261 San Pedro Pl # 409
Los Angeles
CA 90011-2917
Mailing Telephone 3107706749
Enumeration Date 2018-06-07
Last Update Date 2018-06-07
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification Taxonomy Group License Number License State Grouping
Y 101Y00000X Counselor CA Behavioral Health & Social Service Providers

Other Provider Identifiers

Identifier State Issuer Type Code
17773901 CA LA COUNTY VENDOR ID NUMBER Other

Office Location

Street Address 4261 SAN PEDRO PL
City LOS ANGELES
State CA
Zip Code 90011-2917

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1205252533 Jameese B Smith Case Manager/Care Coordinator 271 E. 43rd Street, Los Angeles, CA 90011 2014-03-11
1164941183 Kimberly Denise Lister- Gutierrez Counselor 303 E 52nd Street, Los Angeles, CA 90011 2017-09-11
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1073863445 Ronald Armado Pharmacist 4211 S. Avalon, Los Angeles, CA 90011 2012-09-13
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Taxonomy Information

Taxonomy Code 101Y00000X
Grouping Behavioral Health & Social Service Providers
Classification Counselor

Taxonomy Definition

A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master’s degree and clinical experience and supervision for licensure or certification.
Notes: Sources: Abridged from definitions provided by the National Board of Certified Counselors and the American Association of Pastoral Counselors.

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1467073965 Flowlab Inc Counselor 4528 Los Feliz Blvd, Los Angeles, CA 90027-2006 2020-05-06
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Competitor

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City LOS ANGELES
Zip Code 90011

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.