Bill D. Graham, PHD
Individual provider Active NPI Psychologist · Maryville, MO
NPI 1164428322 · NPPES record last updated Oct 31, 2007
Key facts
- NPI
- 1164428322
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- 00259 (MO)
- Practice address
- 1212 S Main St
Maryville, MO 64468-2604 - Phone
- (660) 582-8340
- NPI assigned
- Jun 22, 2005
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 00259 | MO | Yes |
| Counseling Psychologist | 103TC1900X | 00259 | MO |
Addresses
Primary practice location
1212 S Main St
Maryville, MO 64468-2604
Mailing address
1212 S Main St
Maryville, MO 64468-2604
Phone (660) 582-8340
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| B840860 | Other | MO | MEDICARE |
Other providers in Maryville, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 31, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.