Provider Demographics
NPI:1861506651
Name:GRAHAM, LAUREL V (MA, LPC)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:V
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 E MOCKINGBIRD LN
Mailing Address - Street 2:SUITE #275
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-2139
Mailing Address - Country:US
Mailing Address - Phone:361-575-4351
Mailing Address - Fax:361-575-1497
Practice Address - Street 1:1501 E MOCKINGBIRD LN
Practice Address - Street 2:SUITE #275
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-2139
Practice Address - Country:US
Practice Address - Phone:361-575-4351
Practice Address - Fax:361-575-1497
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12083101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health