Provider Demographics
NPI:1629541461
Name:GRAHAM, JUDY ELAINE (LCSW)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:ELAINE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6333 E. MOCKINGBIRD LANE, STE 147, #637
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-2672
Mailing Address - Country:US
Mailing Address - Phone:214-770-7056
Mailing Address - Fax:
Practice Address - Street 1:4546 BUNKER HILL RD
Practice Address - Street 2:
Practice Address - City:SACHSE
Practice Address - State:TX
Practice Address - Zip Code:75048-4317
Practice Address - Country:US
Practice Address - Phone:214-770-7056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX095351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical