Individual
MR. TIMOTHY GABRIEL GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSS, CRM
Contact information
Practice address
17440 NE FLANDERS ST, PORTLAND, OR 97230-6632
(760) 529-2076
Mailing address
8915 SW CENTER ST, TIGARD, OR 97223-6307
(760) 726-3690
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
101YM0800X
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
24-CRM-4000
PSS CERTIFICATION (MHACBO)
OR
Enumeration date
01/06/2025
Last updated
04/21/2025
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