Healthcare Provider Details

I. General information

NPI: 1972649671
Provider Name (Legal Business Name): CHRISTY LYNN GRAHAM LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16421 N TATUM BLVD STE 130
PHOENIX AZ
85032-3444
US

IV. Provider business mailing address

16421 N TATUM BLVD STE 130
PHOENIX AZ
85032-3444
US

V. Phone/Fax

Practice location:
  • Phone: 602-339-5471
  • Fax: 602-258-6140
Mailing address:
  • Phone: 602-339-5471
  • Fax: 866-370-1447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW2721
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: