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General NPI Number Information
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NPI Number | 1760624654
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Entity Type | Individual
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Provider Name | ATHENA FELICIA GRIJALVA MA, LMFT
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Gender | Female
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Dates
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Enumeration Date | 03/24/2009
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Last Update Date | 03/24/2009
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Provider Practice Location Address
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Address Line | 2217 CAPITOL WAY S
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City | OLYMPIA
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State | WA
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Zip | 98501-2830
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Country | US
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Telephone | 360-259-4223
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Fax |
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Provider Business Mailing Address
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Address Line | 7133 RADIUS LOOP SE
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City | LACEY
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State | WA
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Zip | 98513-5140
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Country | US
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Telephone | 360-259-4223
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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 | LF 00001986
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License Number State | WA
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