MEDICARE: C GRAHAM LCSW LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1689380180
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C GRAHAM LCSW LLC

Provider Business Mailing Address
First Line	:	1305 S 5TH ST
Second Line	:
City	:	MCALESTER
State	:	OK
Zip	:	74501-6815
Country	:	US
Telephone Number	:	225-290-3559
Fax Number	:

Provider Business Practice Location Address
First Line	:	609 S 2ND ST
Second Line	:
City	:	MCALESTER
State	:	OK
Zip	:	74501-5813
Country	:	US
Telephone Number	:	225-290-3559
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHRISTOPHER G GRAHAM
Credential	:	DSW, LCSW, BAS
Telephone Number	:	225-290-3559

Provider Enumeration Date	:	01/27/2023
Last Update Date	:	01/27/2023

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