Provider Demographics
NPI:1801987581
Name:GRAHAM, ALAN R (PHD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:R
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1580 N NORTHWEST HWY
Mailing Address - Street 2:SUITE 311D
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1444
Mailing Address - Country:US
Mailing Address - Phone:847-824-1235
Mailing Address - Fax:847-824-2386
Practice Address - Street 1:1580 N NORTHWEST HWY
Practice Address - Street 2:SUITE 311D
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1444
Practice Address - Country:US
Practice Address - Phone:847-824-1235
Practice Address - Fax:847-824-2386
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071002526103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical