Provider Demographics
NPI:1841798469
Name:GRAHAM, MARK D (LMFT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:D
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23044 ENADIA WAY
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-2208
Mailing Address - Country:US
Mailing Address - Phone:818-219-8327
Mailing Address - Fax:
Practice Address - Street 1:23044 ENADIA WAY
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-2208
Practice Address - Country:US
Practice Address - Phone:818-219-8327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88925106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist