Provider Demographics
NPI:1710178330
Name:GRAHAM, DANA LEANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:LEANN
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 1:1800 N INTERSTATE DR
Mailing Address - Street 2:DILLARD EXECUTIVE SUITES, SUITE 116
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-2993
Mailing Address - Country:US
Mailing Address - Phone:405-290-1436
Mailing Address - Fax:405-290-1450
Practice Address - Street 1:1800 N INTERSTATE DR
Practice Address - Street 2:DILLARD EXECUTIVE SUITES, SUITE 116
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-2993
Practice Address - Country:US
Practice Address - Phone:405-290-1436
Practice Address - Fax:405-290-1450
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100716710AMedicaid
OK100716710AMedicaid