Active NPI
Clifford Ray Graham, PH.D.
- Clinical Psychologist
- Redding, CA
National Provider Identifier
1265449953
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY5631
- Practice address
- 1211 Magnolia Ave Ste D
Redding, CA 96001-1522 - Phone
- (530) 245-0502
- Fax
- (530) 244-4338
- NPI assigned
- Aug 2, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY5631 | CA | Primary |
Addresses
Primary practice location
1211 Magnolia Ave Ste D
Redding, CA 96001-1522
Mailing address
1211 Magnolia Ave
Suite D
Redding, CA 96001-1522
Phone (530) 245-0502
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PSY056310 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY5631 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1376870400000",
"number": "1265449953",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1211 MAGNOLIA AVE",
"address_2": "SUITE D",
"city": "REDDING",
"state": "CA",
"postal_code": "960011522",
"telephone_number": "530-245-0502",
"fax_number": "530-244-4338"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1211 MAGNOLIA AVE STE D",
"city": "REDDING",
"state": "CA",
"postal_code": "960011522",
"telephone_number": "530-245-0502",
"fax_number": "530-244-4338"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAHAM",
"first_name": "CLIFFORD",
"middle_name": "RAY",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-02",
"last_updated": "2013-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY5631",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PSY056310",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Redding, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.