Healthcare Provider Details

I. General information

NPI: 1013836097
Provider Name (Legal Business Name): CHARISA BETH GRAHAM LPC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 WILLIAM D TATE AVE
GRAPEVINE TX
76051-7106
US

IV. Provider business mailing address

8500 HARWOOD RD APT 2815
NORTH RICHLAND HILLS TX
76180-0410
US

V. Phone/Fax

Practice location:
  • Phone: 817-421-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: