Provider Demographics
NPI:1164930988
Name:GRAHAM, LAURA W (RBT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:W
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12703 LA QUINTA ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78233-5848
Mailing Address - Country:US
Mailing Address - Phone:210-380-9147
Mailing Address - Fax:
Practice Address - Street 1:12703 LA QUINTA ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78233-5848
Practice Address - Country:US
Practice Address - Phone:210-380-9147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-15
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician