1205266046 NPI number — MS. DEBORAH LYNNE GRIGSBY LPC, NCC, MA-MHC

Table of content: MS. DEBORAH LYNNE GRIGSBY LPC, NCC, MA-MHC (NPI 1205266046)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205266046 NPI number — MS. DEBORAH LYNNE GRIGSBY LPC, NCC, MA-MHC

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:
GRIGSBY

Provider First Name:
DEBORAH

Provider Middle Name:
LYNNE

Provider Name Prefix Text:
MS.

Provider Name Suffix Text:

Provider Credential Text:
LPC, NCC, MA-MHC

Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:
BENARD

Provider Other First Name:
DEBORAH

Provider Other Middle Name:
LYNNE

Provider Other Name Prefix Text:
MS.

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1205266046

Entity Type Code:
Individual

Replacement NPI:

Last Update Date:
09/08/2016

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2566

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:
FLORENCE

Provider Business Mailing Address State Name:
OR

Provider Business Mailing Address Postal Code:
97439

Provider Business Mailing Address Country Code:
US

Provider Business Mailing Address Telephone Number:
541-999-1913

Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1490 1ST STREET, UNIT #1

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:
FLORENCE

Provider Business Practice Location Address State Name:
OR

Provider Business Practice Location Address Postal Code:
97439

Provider Business Practice Location Address Country Code:
US

Provider Business Practice Location Address Telephone Number:
541-999-1913

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:
11/14/2013

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: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Taxonomy code: 101YM0800X , with the licence number: C4249 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .