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General NPI Number Information
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NPI Number | 1548026362
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Entity Type | Individual
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Provider Name | STEPHANIE LYNN GRIZZARD LPC-A
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Gender | Female
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Dates
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Enumeration Date | 02/28/2024
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Last Update Date | 02/28/2024
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Provider Practice Location Address
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Address Line | 3223 S LOOP 289 STE 320
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City | LUBBOCK
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State | TX
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Zip | 79423-1367
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Country | US
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Telephone | 806-318-8448
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Fax |
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Provider Business Mailing Address
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Address Line | 5410 24TH ST
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City | LUBBOCK
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State | TX
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Zip | 79407-2130
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Country | US
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Telephone | 817-559-2084
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 94413
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License Number State | TX
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