Provider Demographics
NPI:1093137028
Name:GRAHAM, JULISA NAOMI
Entity Type:Individual
Prefix:MRS
First Name:JULISA
Middle Name:NAOMI
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JULISA
Other - Middle Name:NAOMI
Other - Last Name:LIGHTBOURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5840 CORPORATE WAY STE 105
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2040
Mailing Address - Country:US
Mailing Address - Phone:855-274-1915
Mailing Address - Fax:
Practice Address - Street 1:5840 CORPORATE WAY STE 105
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2040
Practice Address - Country:US
Practice Address - Phone:855-274-1915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-10
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst