MEDICARE: GRACE CATHERINE GRAHAM

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1245122308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE CATHERINE GRAHAM

Provider Business Mailing Address
First Line	:	421 E PAMS DR
Second Line	:
City	:	PERKINS
State	:	OK
Zip	:	74059-5011
Country	:	US
Telephone Number	:	918-510-9637
Fax Number	:

Provider Business Practice Location Address
First Line	:	6711 S YALE AVE STE 106
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-3317
Country	:	US
Telephone Number	:	918-488-8002
Fax Number	:

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

Provider Enumeration Date	:	07/15/2025
Last Update Date	:	07/15/2025

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Directions to “ GRACE CATHERINE GRAHAM ” Practice Location

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