MEDICARE: SCOTT GRIZZLE LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	78527	TX

General Provider Information

NPI Number	:	1093352072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT GRIZZLE LPC

Provider Business Mailing Address
First Line	:	4024 CHAPEL QUARTERS
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75707-5483
Country	:	US
Telephone Number	:	903-576-9003
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 PALUXY DR STE 431
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75703-1659
Country	:	US
Telephone Number	:	903-576-9003
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2019
Last Update Date	:	08/04/2020

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Directions to “ SCOTT GRIZZLE LPC” Practice Location

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