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General NPI Number Information
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NPI Number | 1174634752
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Entity Type | Individual
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Provider Name | KIRSTEN LEE GRIGGS LCPC
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 310 N 2ND E STE 114
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City | REXBURG
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State | ID
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Zip | 83440-1606
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Country | US
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Telephone | 208-359-0581
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Fax | 208-359-1125
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Provider Business Mailing Address
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Address Line | PO BOX 420
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City | SUGAR CITY
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State | ID
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Zip | 83448-0420
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Country | US
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Telephone | 208-390-4122
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Fax | 208-359-1125
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LCPC-371
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License Number State | ID
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