Provider Demographics
NPI:1518732825
Name:GRAHAM, CRYSTAL (LMFTA)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 BURKE RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77502-3010
Mailing Address - Country:US
Mailing Address - Phone:832-270-6955
Mailing Address - Fax:
Practice Address - Street 1:1560 W BAY AREA BLVD STE 303
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-2681
Practice Address - Country:US
Practice Address - Phone:832-224-9143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205118106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist