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General NPI Number Information
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NPI Number | 1467215038
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Entity Type | Individual
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Provider Name | MELISSA GRISDALE PHD
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Gender | Female
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Dates
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Enumeration Date | 02/05/2024
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 24546 KINGSLAND BLVD
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City | KATY
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State | TX
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Zip | 77494-3429
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Country | US
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Telephone | 832-913-8747
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Fax |
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Provider Business Mailing Address
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Address Line | 1319 SWEET DUMPLING DR
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City | RICHMOND
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State | TX
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Zip | 77406-2830
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Country | US
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Telephone | 713-202-1478
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Fax |
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 71556
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 38631
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License Number State | TX
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