Organization
GRAHAM PSHCHOLOGICAL CONSULTING AND RESTORATION, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA GRAHAM PSYD HSPP (OWNER)
(779) 275-1710
Entity
Organization
Contact information
Practice address
9111 BROADWAY, SUITE Q, MERRILLVILLE, IN 46410-8122
(773) 501-3557
(773) 275-1710
Mailing address
5425 N PAULINA ST, UNIT 2 NORTH, CHICAGO, IL 60640-1139
(773) 501-3557
(773) 275-1710
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20042049
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20042049
INDIANA LICENSE NUMBER
IN
Enumeration date
08/27/2007
Last updated
09/13/2007
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