Provider Demographics
NPI:1215092721
Name:GRAHAM, PETER (PHD CLINICAL PSYCH)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:PHD CLINICAL PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 KENTUCKY ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-2823
Mailing Address - Country:US
Mailing Address - Phone:785-856-8218
Mailing Address - Fax:785-841-8781
Practice Address - Street 1:901 KENTUCKY ST
Practice Address - Street 2:SUITE 301
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2823
Practice Address - Country:US
Practice Address - Phone:785-856-8218
Practice Address - Fax:785-841-8781
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS859103TA0700X, 103TB0200X, 103TC0700X, 103TF0200X, 103T00000X, 103TP0814X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS119869Medicare ID - Type Unspecified
KSR86082Medicare UPIN