Provider Demographics
NPI:1265449953
Name:GRAHAM, CLIFFORD RAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:RAY
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 MAGNOLIA AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1522
Mailing Address - Country:US
Mailing Address - Phone:530-245-0502
Mailing Address - Fax:530-244-4338
Practice Address - Street 1:1211 MAGNOLIA AVE STE D
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1522
Practice Address - Country:US
Practice Address - Phone:530-245-0502
Practice Address - Fax:530-244-4338
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5631103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY056310Medicaid
CAPSY056310Medicaid