Individual
THOMAS WILLIAM GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, LLP
Contact information
Practice address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 455-5000
Mailing address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 455-5000
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301010627
MI
104100000X
Social Worker
6801013765
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P108965270
BC/BS
MI
Enumeration date
06/22/2006
Last updated
11/08/2010
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