MEDICARE: GRAHAM PSYCHOLOGICAL CONSULTING, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	071007159	IL

General Provider Information

NPI Number	:	1144548934
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAHAM PSYCHOLOGICAL CONSULTING, INC

Provider Business Mailing Address
First Line	:	3831 KIRK ST
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60076-3419
Country	:	US
Telephone Number	:	773-501-3557
Fax Number	:

Provider Business Practice Location Address
First Line	:	1112 US HIGHWAY 41 STE 108
Second Line	:
City	:	SCHERERVILLE
State	:	IN
Zip	:	46375-1361
Country	:	US
Telephone Number	:	773-501-3557
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	DR. PATRICIA ANNA GRAHAM
Credential	:	PSY.D.
Telephone Number	:	773-501-3557

Provider Enumeration Date	:	05/04/2010
Last Update Date	:	10/06/2023

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