Provider Demographics
NPI:1376725341
Name:GRAHAM, LAURIE (CRC, LRC)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:CRC, LRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 TARRYTOWN MALL
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-4516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:713-780-0567
Practice Address - Street 1:3915 SOUTH SHAVER ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504
Practice Address - Country:US
Practice Address - Phone:713-378-0030
Practice Address - Fax:713-378-0399
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00048019225C00000X
LA712225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor