MEDICARE: SULTANA GRAHAM LCSW, LISAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	60818454	WA
2	1041C0700X	Clinical Social Worker	LW60585865	WA

General Provider Information

NPI Number	:	1154761781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SULTANA GRAHAM LCSW, LISAC

Provider Business Mailing Address
First Line	:	PO BOX 69072
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85737-0010
Country	:	US
Telephone Number	:	520-910-2573
Fax Number	:

Provider Business Practice Location Address
First Line	:	6885 N ORACLE RD STE D
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-4222
Country	:	US
Telephone Number	:	520-910-2573
Fax Number	:	425-278-6069

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2013
Last Update Date	:	03/23/2026

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