Provider Demographics
NPI:1710059068
Name:GRAHAM, LOIS JEANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LOIS
Middle Name:JEANNE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4807 SPICEWOOD SPRINGS RD
Mailing Address - Street 2:B1 S1120
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8444
Mailing Address - Country:US
Mailing Address - Phone:512-346-0079
Mailing Address - Fax:
Practice Address - Street 1:4807 SPICEWOOD SPRINGS RD
Practice Address - Street 2:B1 S1120
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8444
Practice Address - Country:US
Practice Address - Phone:512-346-0079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24521103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical