Tina Kathleen Graham, PLPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

2021046275 Issued in MO

Practice address

1001 Boardwalk Springs PL Ste 111
O Fallon, MO 63368-4777

Phone

(636) 284-0408

NPI assigned

Dec 30, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1640822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640822400000",
    "number": "1740940840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "545 TURKEY CALL CT",
            "city": "TROY",
            "state": "MO",
            "postal_code": "633792556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 BOARDWALK SPRINGS PL STE 111",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633684777",
            "telephone_number": "636-284-0408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "TINA",
        "middle_name": "KATHLEEN",
        "credential": "PLPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-12-30",
        "last_updated": "2021-12-30",
        "certification_date": "2021-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "MO",
            "license": "2021046275",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ranjita Gosain
• Natalie Gough, LCSW
• Bradly Gould, DC
• Sara C Gozdecki, FNP-C
• John Ellington Graham III, MA, MSED
• Grant Ventures LLC
• David Dupriest Grant, LCSW
• Rebecca Graue, PT, DPT
• Amy Elizabeth Grawey, M.D.
• Gary D Gray, MD

• Mental Health Counselor in O Fallon, MO
• Providers in O Fallon, MO by specialty
• Mental Health Counselor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2021; 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.