Provider Demographics
NPI:1164237152
Name:QUATTLEBAUM, GRAHAM HOLLIS
Entity type:Individual
Prefix:
First Name:GRAHAM
Middle Name:HOLLIS
Last Name:QUATTLEBAUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 NORTHRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-3724
Mailing Address - Country:US
Mailing Address - Phone:214-564-9581
Mailing Address - Fax:
Practice Address - Street 1:5005 COLLEYVILLE BLVD STE 202
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-5864
Practice Address - Country:US
Practice Address - Phone:214-564-9581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-08
Last Update Date:2025-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX94918101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health