Individual
DR. BILL D. GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1212 S MAIN ST, MARYVILLE, MO 64468-2604
(660) 582-8340
Mailing address
1212 S MAIN ST, MARYVILLE, MO 64468-2604
(660) 582-8340
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
00259
MO
103TC1900X
Counseling Psychologist
00259
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B840860
MEDICARE
MO
Enumeration date
06/22/2005
Last updated
10/31/2007
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