Provider Demographics
NPI:1033974688
Name:GRAHAM, TANESHA LOMASI (LPC)
Entity Type:Individual
Prefix:
First Name:TANESHA
Middle Name:LOMASI
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 1:2190 S UECKER LN APT 638
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-7862
Mailing Address - Country:US
Mailing Address - Phone:940-634-7426
Mailing Address - Fax:
Practice Address - Street 1:2190 S UECKER LN APT 638
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-7862
Practice Address - Country:US
Practice Address - Phone:940-634-7426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88765101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional