Healthcare Provider Details

I. General information

NPI: 1609244011
Provider Name (Legal Business Name): KATHRYN N. GRIESER LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 09/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 N 18TH ST STE 101
LAFAYETTE IN
47904-3413
US

IV. Provider business mailing address

615 N 18TH ST STE 101
LAFAYETTE IN
47904-3413
US

V. Phone/Fax

Practice location:
  • Phone: 765-423-5361
  • Fax: 765-742-8272
Mailing address:
  • Phone: 765-423-5361
  • Fax: 765-742-8272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number87000079A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number33002864A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35000365A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: