Provider Demographics
NPI:1265810220
Name:GRAHAM, CRYSTAL (LCSW)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7005 WOODWAY DR
Mailing Address - Street 2:STE 101
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6169
Mailing Address - Country:US
Mailing Address - Phone:254-741-6614
Mailing Address - Fax:
Practice Address - Street 1:7005 WOODWAY DR
Practice Address - Street 2:STE 101
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6169
Practice Address - Country:US
Practice Address - Phone:254-741-6614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX567241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical