Healthcare Provider Details

I. General information

NPI: 1346793627
Provider Name (Legal Business Name): GAIL GRIEMSMANN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2016
Last Update Date: 12/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 W DUNLAP AVE SUITE 300
PHOENIX AZ
85021-2817
US

IV. Provider business mailing address

3003 N CENTRAL AVE SUITE 200
PHOENIX AZ
85012-2902
US

V. Phone/Fax

Practice location:
  • Phone: 602-685-6000
  • Fax: 602-943-4284
Mailing address:
  • Phone: 602-685-6000
  • Fax: 602-302-7925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-10520
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: