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General NPI Number Information
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NPI Number | 1548628423
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Entity Type | Individual
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Provider Name | JEREMIAH EDWARD GRISSETT M.S.
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Gender | Male
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Dates
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Enumeration Date | 02/05/2016
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Last Update Date | 02/05/2016
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Provider Practice Location Address
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Address Line | 121 S DUCK ST
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City | STILLWATER
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State | OK
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Zip | 74074-3292
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Country | US
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Telephone | 405-372-7791
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Fax |
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Provider Business Mailing Address
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Address Line | 400 S SQUIRES LANDING BLVD APT. J4
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City | STILLWATER
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State | OK
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Zip | 74074-2335
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Country | US
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Telephone | 256-348-3422
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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