Healthcare Provider Details

I. General information

NPI: 1144548934
Provider Name (Legal Business Name): GRAHAM PSYCHOLOGICAL CONSULTING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2010
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 US HIGHWAY 41 STE 108
SCHERERVILLE IN
46375-1361
US

IV. Provider business mailing address

3831 KIRK ST
SKOKIE IL
60076-3419
US

V. Phone/Fax

Practice location:
  • Phone: 773-501-3557
  • Fax:
Mailing address:
  • Phone: 773-501-3557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071007159
License Number StateIL

VIII. Authorized Official

Name: DR. PATRICIA ANNA GRAHAM
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSY.D.
Phone: 773-501-3557