Provider Demographics
NPI:1316382062
Name:GRAHAM AND AWTREY PSYCHOLOGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:GRAHAM AND AWTREY PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:409-489-1100
Mailing Address - Street 1:402 PAINT BRUSH CIR
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-5345
Mailing Address - Country:US
Mailing Address - Phone:409-489-1100
Mailing Address - Fax:936-634-7631
Practice Address - Street 1:76 US HIGHWAY 190 W
Practice Address - Street 2:
Practice Address - City:WOODVILLE
Practice Address - State:TX
Practice Address - Zip Code:75979-9714
Practice Address - Country:US
Practice Address - Phone:409-489-1100
Practice Address - Fax:936-634-7631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18076101YP2500X
TX21232103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty