Provider Demographics
NPI:1538337159
Name:GRAHAM-DOUGLAS, SAMANTHA L (LPC)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:L
Last Name:GRAHAM-DOUGLAS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 WILD TURKEY LN
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63379-4339
Mailing Address - Country:US
Mailing Address - Phone:636-358-6021
Mailing Address - Fax:636-338-4203
Practice Address - Street 1:681 S LINCOLN DR STE 3
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MO
Practice Address - Zip Code:63379-2835
Practice Address - Country:US
Practice Address - Phone:636-528-4333
Practice Address - Fax:636-338-4203
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-17
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007035322101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional