Provider Demographics
NPI:1255121695
Name:GRAHAM, MICHAEL JR
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:GRAHAM
Suffix:JR
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 SUTTER ST STE 405
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-4618
Mailing Address - Country:US
Mailing Address - Phone:415-992-6155
Mailing Address - Fax:650-360-6913
Practice Address - Street 1:332 S MICHIGAN AVE STE 900
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-4393
Practice Address - Country:US
Practice Address - Phone:415-992-6155
Practice Address - Fax:650-360-6913
Is Sole Proprietor?:No
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178016687101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional