Individual provider Active NPI

Michele A Graham, B.S. PSYCHOLOGY

  • Behavior Analyst
  • Poteau, OK
National Provider Identifier
1679955199
Registry record updated Jun 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
A64262191 Issued in VA
Practice address
205 Dewey Ave
Poteau, OK 74953-4224
Phone
(918) 649-0909
NPI assigned
Jun 20, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X A64262191 VA Primary

Addresses

Primary practice location

205 Dewey Ave
Poteau, OK 74953-4224

Mailing address

205 Dewey Ave
Poteau, OK 74953-4224
Phone (918) 649-0909

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
Credentials
Bachelor of Science

State licenses

LicenseStateTypeSpecialty
A64262191VAMDBehavioral Analyst

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1434758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1434758400000",
    "number": "1679955199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 DEWEY AVE",
            "city": "POTEAU",
            "state": "OK",
            "postal_code": "749534224",
            "telephone_number": "918-649-0909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 DEWEY AVE",
            "city": "POTEAU",
            "state": "OK",
            "postal_code": "749534224",
            "telephone_number": "918-649-0909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "MICHELE",
        "middle_name": "A",
        "credential": "B.S. PSYCHOLOGY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-20",
        "last_updated": "2015-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "VA",
            "license": "A64262191",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Poteau, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.