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NPI Code Detail

MEDICARE: MRS. MELANDY MIA GRIGSBY M. S.

MEDICARE:  MRS. MELANDY MIA GRIGSBY  M. S.
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
1101YM0800XMental Health Counselor
2101YM0800XMental Health CounselorMA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1194039800
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MELANDY MIA GRIGSBY M. S.
Provider Business Mailing Address
First Line : 6511 EMERALD DUNES DR APT 208
Second Line :
City : ROYAL PALM BEACH
State : FL
Zip : 33411-2771
Country : US
Telephone Number : 413-821-4088
Fax Number :
Provider Business Practice Location Address
First Line : 6511 EMERALD DUNES DR APT 208
Second Line :
City : ROYAL PALM BEACH
State : FL
Zip : 33411-2771
Country : US
Telephone Number : 413-821-4088
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2010
Last Update Date : 11/18/2021

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