Healthcare Provider Details

I. General information

NPI: 1053237982
Provider Name (Legal Business Name): LAUREN ANDREA GRINSTAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 E CHANDLER BLVD APT 2025
PHOENIX AZ
85048-7669
US

IV. Provider business mailing address

4411 E CHANDLER BLVD APT 2025
PHOENIX AZ
85048-7669
US

V. Phone/Fax

Practice location:
  • Phone: 480-621-9287
  • Fax:
Mailing address:
  • Phone: 480-621-9287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: