Provider Demographics
NPI:1932157963
Name:GRAHAM, JAMIE LORETTE (LAC)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:LORETTE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6515 SANGER AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-7806
Mailing Address - Country:US
Mailing Address - Phone:254-759-8050
Mailing Address - Fax:
Practice Address - Street 1:6515 SANGER AVE STE 1
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-7806
Practice Address - Country:US
Practice Address - Phone:254-759-8050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00741171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist