MEDICARE: HOLLY P GRIGSBY MA, LMHC

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	101YM0800X	Mental Health Counselor	LH60835736	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	260471	OTHER	WA	FIRST CHOICE HEALTH NETWORK
2	6613862	OTHER	WA	AETNA

General Provider Information

NPI Number	:	1821530676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY P GRIGSBY MA, LMHC

Provider Business Mailing Address
First Line	:	3213 HARBOR AVE SW STE 1
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98126-4600
Country	:	US
Telephone Number	:	206-552-0504
Fax Number	:

Provider Business Practice Location Address
First Line	:	3213 HARBOR AVE SW STE 1
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98126-4600
Country	:	US
Telephone Number	:	206-552-0504
Fax Number	:

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

Provider Enumeration Date	:	11/10/2016
Last Update Date	:	05/23/2023

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