Provider Demographics
NPI:1982388229
Name:GRAHAM, TANESHA NICOLE (MBA, CBHC)
Entity Type:Individual
Prefix:
First Name:TANESHA
Middle Name:NICOLE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MBA, CBHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1795 FRY RD # 459
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-3347
Mailing Address - Country:US
Mailing Address - Phone:832-529-2696
Mailing Address - Fax:
Practice Address - Street 1:5346 SUMMIT LODGE DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-7461
Practice Address - Country:US
Practice Address - Phone:832-529-2696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach