Provider Demographics
NPI:1902044266
Name:GRAHAM, ROSALIND MASHAY (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ROSALIND
Middle Name:MASHAY
Last Name:GRAHAM
Suffix:
Gender:F
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:PO BOX 383184
Mailing Address - Street 2:BLDG. B. SUITE 413
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38183-3184
Mailing Address - Country:US
Mailing Address - Phone:901-502-3464
Mailing Address - Fax:901-842-9391
Practice Address - Street 1:2506 MOUNT MORIAH RD
Practice Address - Street 2:BLDG. B. STE. 413
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-1511
Practice Address - Country:US
Practice Address - Phone:901-217-1947
Practice Address - Fax:901-842-9391
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-25
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2308106H00000X
TNLMT0000000886106H00000X
ARM1008006106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist