Provider Demographics
NPI:1164960522
Name:GRAHAM, TAMARA (MSW)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:
Other - Last Name:SPANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:115 GRAND AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-2000
Mailing Address - Country:US
Mailing Address - Phone:970-874-0464
Mailing Address - Fax:
Practice Address - Street 1:515 28 3/4 RD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-5016
Practice Address - Country:US
Practice Address - Phone:970-263-4918
Practice Address - Fax:970-683-7278
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health