Active NPI
Monica L Randolph-Graham, PSYD, LPC-S
- Professional Counselor
- Roanoke, TX
National Provider Identifier
1659549137
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 19708
- Practice address
- 5360 Kelly Dr
Roanoke, TX 76262-3617 - Phone
- (817) 714-6439
- NPI assigned
- Feb 18, 2008
- Last updated
- Jun 25, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 19708 | TX | |
| Professional Counselor | 101YP2500X | 19708 | TX | Primary |
Addresses
Primary practice location
5360 Kelly Dr
Roanoke, TX 76262-3617
Mailing address
5360 Kelly Dr
Roanoke, TX 76262-3617
Phone (817) 714-6439
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 88600L | Other | TX | BLUECROSSBLUESHIELD PROV# |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19708 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203292800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340582400000",
"number": "1659549137",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5360 KELLY DR",
"city": "ROANOKE",
"state": "TX",
"postal_code": "762623617",
"telephone_number": "817-714-6439"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5360 KELLY DR",
"city": "ROANOKE",
"state": "TX",
"postal_code": "762623617",
"telephone_number": "817-714-6439"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDOLPH-GRAHAM",
"first_name": "MONICA",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "PSYD, LPC-S",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-02-18",
"last_updated": "2012-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "TX",
"license": "19708",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "19708",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSSBLUESHIELD PROV#",
"identifier": "88600L",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Roanoke, TX
- Professional Dental Alliance of TX 43003 PLLC
- Psychology Care Associates PLLC
- Q. D. Nguyen PLLC
- Valerie R Quinn, PMHNP
- Randolph R West DDS PLLC (West Dental Care)
- Stephanie Nicole Raymond, R.D.H.
- Rediclinic US, LLC (Rediclinic)
- Elena Riedo, PSY.D.
- Alejandra Cristina Rivas, DDS
- RLS Supermarkets LLC (Minyard Pharmacy #49)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.