Provider Demographics
NPI:1609148840
Name:DANA L. GRAHAM LCSW, PLLC
Entity Type:Organization
Organization Name:DANA L. GRAHAM LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-290-1436
Mailing Address - Street 1:1800 N INTERSTATE DR STE 116
Mailing Address - Street 2:DILLARD GROUP EXECUTIVE SUITES
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-2995
Mailing Address - Country:US
Mailing Address - Phone:405-290-1436
Mailing Address - Fax:405-290-1450
Practice Address - Street 1:1800 N INTERSTATE DR STE 116
Practice Address - Street 2:DILLARD GROUP EXECUTIVE SUITES
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-2995
Practice Address - Country:US
Practice Address - Phone:405-290-1436
Practice Address - Fax:405-290-1450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100716710AMedicaid
OKOKAAA1657Medicare UPIN