Provider Demographics
NPI:1972649671
Name:GRAHAM, CHRISTY LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:LYNN
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16421 N TATUM BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-3444
Mailing Address - Country:US
Mailing Address - Phone:602-339-5471
Mailing Address - Fax:866-370-1447
Practice Address - Street 1:16421 N TATUM BLVD STE 130
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-3444
Practice Address - Country:US
Practice Address - Phone:602-339-5471
Practice Address - Fax:602-258-6140
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW27211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ101224Medicare PIN