Provider Demographics
NPI:1659061588
Name:GRAHAM, CHARISSA (AMFT)
Entity Type:Individual
Prefix:
First Name:CHARISSA
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:CHRISSY
Other - Middle Name:
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1095 STAFFORD WAY STE J
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-3333
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:580 MANZANITA AVE STE 9
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1338
Practice Address - Country:US
Practice Address - Phone:530-434-6318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA134731106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist