Provider Demographics
NPI:1811248255
Name:GRAHAM, GEORGE HENRY III (PHD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:HENRY
Last Name:GRAHAM
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9310 PIPILO ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-3576
Mailing Address - Country:US
Mailing Address - Phone:858-538-2650
Mailing Address - Fax:
Practice Address - Street 1:9310 PIPILO ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-3576
Practice Address - Country:US
Practice Address - Phone:858-538-2650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18665103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral