Provider Demographics
NPI:1407243694
Name:GRAHAM, JAZMIN (LCSW)
Entity Type:Individual
Prefix:
First Name:JAZMIN
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JAZMIN
Other - Middle Name:
Other - Last Name:HUNTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2404 ELLIS STREET
Mailing Address - Street 2:SUITE 4
Mailing Address - City:VENUS
Mailing Address - State:TX
Mailing Address - Zip Code:76084-2491
Mailing Address - Country:US
Mailing Address - Phone:817-372-0784
Mailing Address - Fax:
Practice Address - Street 1:2404 ELLIS ST
Practice Address - Street 2:SUITE #4
Practice Address - City:VENUS
Practice Address - State:TX
Practice Address - Zip Code:76084
Practice Address - Country:US
Practice Address - Phone:817-372-0784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-25
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX553521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical