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General NPI Number Information
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NPI Number | 1710360177
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Entity Type | Organization
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Legal Business Name | MARILYN GRAHAM LMFT
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Dates
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Enumeration Date | 07/02/2015
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Last Update Date | 07/02/2015
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Provider Practice Location Address
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Address Line | 6489 CAMDEN AVE STE. 103
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City | SAN JOSE
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State | CA
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Zip | 95120-2849
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Country | US
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Telephone | 408-458-0617
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 41171
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City | SAN JOSE
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State | CA
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Zip | 95160-1171
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Country | US
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Telephone | 408-458-0617
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Fax |
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Authorized Official
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Title or Position | LICENSED MARRIAGE FAMILY THERAPIST
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Name | DR. MARILYN GRAHAM
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Credential | PH.D., LMFT
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Telephone | 408-458-0617
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | MFC52619
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License Number State | CA
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