Provider Demographics
NPI:1821799115
Name:GRAHAM, MORGAN DEVERE (BA, MA)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:DEVERE
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:BA, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 SANTA FE ST
Mailing Address - Street 2:
Mailing Address - City:RIVERBANK
Mailing Address - State:CA
Mailing Address - Zip Code:95367-2524
Mailing Address - Country:US
Mailing Address - Phone:209-238-7580
Mailing Address - Fax:
Practice Address - Street 1:4200 SANTA FE ST
Practice Address - Street 2:
Practice Address - City:RIVERBANK
Practice Address - State:CA
Practice Address - Zip Code:95367-2524
Practice Address - Country:US
Practice Address - Phone:209-238-7580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician