Provider Demographics
NPI:1619732526
Name:GRAFFAGNINO, TANJA (QMHP)
Entity Type:Individual
Prefix:
First Name:TANJA
Middle Name:
Last Name:GRAFFAGNINO
Suffix:
Gender:F
Credentials:QMHP
Other - Prefix:
Other - First Name:TANJA
Other - Middle Name:
Other - Last Name:DEFELICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:GRAFFAGNINO
Mailing Address - Street 1:2205 WILLIAMS TRACE BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4443
Mailing Address - Country:US
Mailing Address - Phone:832-303-2333
Mailing Address - Fax:
Practice Address - Street 1:2205 WILLIAMS TRACE BLVD STE 105
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4443
Practice Address - Country:US
Practice Address - Phone:832-303-2333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-20
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No175T00000XOther Service ProvidersPeer Specialist
No251B00000XAgenciesCase Management