Provider Demographics
NPI:1164660130
Name:GRAHAM, CHELCEY NICHOLE (MED, LPC)
Entity type:Individual
Prefix:
First Name:CHELCEY
Middle Name:NICHOLE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3208 COLE AVE APT 2302
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-1367
Mailing Address - Country:US
Mailing Address - Phone:469-634-6532
Mailing Address - Fax:
Practice Address - Street 1:1345 RIVER BEND DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-6943
Practice Address - Country:US
Practice Address - Phone:214-330-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-29
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75911101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional