Provider Demographics
NPI:1700261906
Name:GRAHAM, REBECCA (PHD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8558 HIGHWAY 23 UNIT 3
Mailing Address - Street 2:
Mailing Address - City:BELLE CHASSE
Mailing Address - State:LA
Mailing Address - Zip Code:70037-2506
Mailing Address - Country:US
Mailing Address - Phone:985-778-3654
Mailing Address - Fax:504-267-2178
Practice Address - Street 1:8558 HIGHWAY 23 UNIT 3
Practice Address - Street 2:
Practice Address - City:BELLE CHASSE
Practice Address - State:LA
Practice Address - Zip Code:70037-2506
Practice Address - Country:US
Practice Address - Phone:985-778-3654
Practice Address - Fax:504-267-2178
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1436103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist