Healthcare Provider Details

I. General information

NPI: 1376862409
Provider Name (Legal Business Name): MELISSA ANNE GRINSLADE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA ANNE FORBES LCSW

II. Dates (important events)

Enumeration Date: 05/28/2010
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 WABASH AVE
TERRE HAUTE IN
47807-3211
US

IV. Provider business mailing address

1111 WABASH AVE
TERRE HAUTE IN
47807-3211
US

V. Phone/Fax

Practice location:
  • Phone: 812-232-4349
  • Fax: 812-298-3291
Mailing address:
  • Phone: 812-232-4349
  • Fax: 812-298-3291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3406429A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: