1740826940 NPI number — ERIN L GRIDER LPCC

Table of content: ERIN L GRIDER LPCC (NPI 1740826940)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740826940 NPI number — ERIN L GRIDER LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRIDER
Provider First Name:
ERIN
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740826940
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1080
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURKESVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42717-1080
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-858-6655
Provider Business Mailing Address Fax Number:
270-858-4607

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2166 S HIGHWAY 127
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUSSELL SPRINGS
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42642-4010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-435-0900
Provider Business Practice Location Address Fax Number:
270-858-4029
Provider Enumeration Date:
11/22/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  260321 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 14578469 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7100637730 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".