=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164668166
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMILY GRIESER PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2008
-----------------------------------------------------
Last Update Date | 04/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 590 MEDICAL CENTER ROAD
-----------------------------------------------------
City | FORT CAVAZOS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76544
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-618-8260
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6406 MANGANITE DR
-----------------------------------------------------
City | KILLEEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76542-3302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-455-5917
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 1689
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------