Ellis Martinez Graham Jr.
Peer Specialist in North Olmsted, OH. Individual provider (NPI-1).
NPI number1962025486
StatusActive
Last updated in NPPESMay 19, 2020
Details
- NPI
- 1962025486
- Entity type
- Individual (NPI-1)
- Name
- Mr. Ellis Martinez Graham Jr.
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- May 19, 2020
- Certification date
- May 19, 2020
- Last updated
- May 19, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 175T00000X | Peer Specialist | – | – | Yes |
Practice location
24695 Maple Ridge RdNorth Olmsted, OH 44070-1274
Phone 216-278-5702
Mailing address
24695 Maple Ridge RdNorth Olmsted, OH 44070-1274
Phone 216-278-5702
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