Provider Demographics
NPI:1669212080
Name:GRAHAM, TYCHELLE (LWSAIC)
Entity type:Individual
Prefix:
First Name:TYCHELLE
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LWSAIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2033 6TH AVE STE 826
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-2593
Mailing Address - Country:US
Mailing Address - Phone:206-414-8918
Mailing Address - Fax:
Practice Address - Street 1:2033 6TH AVE STE 826
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-2593
Practice Address - Country:US
Practice Address - Phone:206-414-8918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61553855104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker