Provider Demographics
NPI:1316086135
Name:GRAHAM, VICKI LYNN (LPC)
Entity type:Individual
Prefix:MS
First Name:VICKI
Middle Name:LYNN
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 VICTORIAN DR
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-6500
Mailing Address - Country:US
Mailing Address - Phone:972-938-0527
Mailing Address - Fax:972-937-9906
Practice Address - Street 1:1626 W HIGHWAY 287 BUSINESS
Practice Address - Street 2:SUITE 104
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-4712
Practice Address - Country:US
Practice Address - Phone:972-935-0027
Practice Address - Fax:972-937-9906
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11300101YP2500X
TX3260106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131262OtherNORTH STAR -VALUE OPTIONS