Provider Demographics
NPI:1871631655
Name:GRAHAM, PAUL DAVID (MA)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:DAVID
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2545 CEANOTHUS AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-7611
Mailing Address - Country:US
Mailing Address - Phone:530-894-6651
Mailing Address - Fax:530-342-2573
Practice Address - Street 1:2545 CEANOTHUS AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-7611
Practice Address - Country:US
Practice Address - Phone:530-894-6651
Practice Address - Fax:530-342-2573
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT #27204106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist