Chanel Kenyata Graham

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

4704352459 Issued in MI

Practice address

7125 Orchard Lake Rd Ste 110
West Bloomfield, MI 48322-3616

Phone

(248) 702-6132

Fax

(248) 702-6133

NPI assigned

May 8, 2024

Sex

Female

Sole proprietor

No

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• River's Bend, P.C.

  • Addiction (Substance Use Disorder) Counselor
  • Troy, MI
  • NPI 1265520209
  NPD (past)

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

{
    "created_epoch": "1715126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720656000000",
    "number": "1790533578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7125 ORCHARD LAKE RD STE 110",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483223616",
            "telephone_number": "248-702-6132",
            "fax_number": "248-702-6133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7125 ORCHARD LAKE RD STE 110",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483223616",
            "telephone_number": "248-702-6132",
            "fax_number": "248-702-6133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "CHANEL",
        "middle_name": "KENYATA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-08",
        "last_updated": "2024-07-11",
        "certification_date": "2024-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MI",
            "license": "4704352459",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kyle E Gortat, PA-C
• Madeline Gottlob
• Terry Ann Gottschall, RPH
• Meghana Govindaraj, BEHAVIOR TECHNICIAN
• Neelima Goyal
• Jeanine L. Graham, R.PH.
• Katharine Elizabeth Graham, DPT
• Michael W Gray, DO
• Great Care Home Services
• Green Lake Opco, LLC (The Villa at Green Lake Estates)

• Psychiatric/Mental Health Nurse Practitioner in West Bloomfield, MI
• Providers in West Bloomfield, MI by specialty
• Psychiatric/Mental Health Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2024; 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.