Individual
MRS. VICKIE ROSELEE GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSBS, MFT-US
Contact information
Practice address
1719 SW 11TH ST, LAWTON, OK 73501-7305
(580) 581-1818
(580) 581-1819
Mailing address
1719 SW 11TH ST, LAWTON, OK 73501-7305
(580) 581-1818
(580) 581-1819
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
106H00000X
Marriage & Family Therapist
Primary
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200392130A
—
OK
Enumeration date
09/26/2011
Last updated
06/06/2012
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