MEDICARE: DR. LOIS JEANNE GRAHAM PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	24521	TX

General Provider Information

NPI Number	:	1710059068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOIS JEANNE GRAHAM PH.D.

Provider Business Mailing Address
First Line	:	4807 SPICEWOOD SPRINGS RD
Second Line	:	B1 S1120
City	:	AUSTIN
State	:	TX
Zip	:	78759-8444
Country	:	US
Telephone Number	:	512-346-0079
Fax Number	:

Provider Business Practice Location Address
First Line	:	4807 SPICEWOOD SPRINGS RD
Second Line	:	B1 S1120
City	:	AUSTIN
State	:	TX
Zip	:	78759-8444
Country	:	US
Telephone Number	:	512-346-0079
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	07/08/2007

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