MEDICARE: MIALAUNI GRIGGS-HOLKE LMFT

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	106H00000X	Marriage & Family Therapist	35002248A	IN
2	106H00000X	Marriage & Family Therapist	166.001562	IL
3	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1407417066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIALAUNI GRIGGS-HOLKE LMFT

Provider Business Mailing Address
First Line	:	7030 INDIANAPOLIS BLVD
Second Line	:
City	:	HAMMOND
State	:	IN
Zip	:	46324-2208
Country	:	US
Telephone Number	:	773-726-7497
Fax Number	:

Provider Business Practice Location Address
First Line	:	7030 INDIANAPOLIS BLVD
Second Line	:
City	:	HAMMOND
State	:	IN
Zip	:	46324-2208
Country	:	US
Telephone Number	:	773-726-7497
Fax Number	:

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

Provider Enumeration Date	:	06/25/2019
Last Update Date	:	10/18/2022

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