Provider Demographics
NPI:1891039327
Name:GRAHAM, RUNZHI (BA)
Entity Type:Individual
Prefix:
First Name:RUNZHI
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:574 PORT TALBOT AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-1294
Mailing Address - Country:US
Mailing Address - Phone:541-680-3228
Mailing Address - Fax:
Practice Address - Street 1:574 PORT TALBOT AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89178-1294
Practice Address - Country:US
Practice Address - Phone:541-680-3228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation