Healthcare Provider Details

I. General information

NPI: 1215922026
Provider Name (Legal Business Name): TERESA ANN GRAHAM LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 WATER AVE NW STE 400
ALBANY OR
97321-2280
US

IV. Provider business mailing address

213 WATER AVE NW STE 400
ALBANY OR
97321-2280
US

V. Phone/Fax

Practice location:
  • Phone: 541-928-3799
  • Fax: 541-967-4251
Mailing address:
  • Phone: 541-928-3799
  • Fax: 541-967-4251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1603
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: