Basic Information
| Provider Information | |||||||||
| NPI: | 1134424278 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRAHAM | ||||||||
| FirstName: | SAMANTHA | ||||||||
| MiddleName: | ERIN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1402 N FLORENCE AVE STE B | ||||||||
| Address2: | |||||||||
| City: | CLAREMORE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740173159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186080380 | ||||||||
| FaxNumber: | 2094255727 | ||||||||
| Practice Location | |||||||||
| Address1: | 8988 S SHERIDAN RD STE D2 | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741335035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186080380 | ||||||||
| FaxNumber: | 2094255727 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/21/2011 | ||||||||
| LastUpdateDate: | 06/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 1041C0700X | 4913 | OK | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.