| Doctor Name: | DR. SAMUEL LEE GRAHAM |
| NPI Number: | 1730181447 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | 435/160 |
| Business Practice Address: | 1000 73rd St Windsor Heights, IA - 503111321 |
| Business Phone Number: | 5152221175 |
| Business Fax Number: | 5152220953 |
| Mailing Address: | 1000 73rd St, WINDSOR HEIGHTS |
| State: | IA |
| Postal Code: | 503111321 |
| Phone Number: | 5152221175 |
| Fax Number: | 5152220953 |
| NPI Enumeration Date: | 08/12/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 435/160 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |