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NPI Code Detail

MEDICARE: LARRY G GRIGSBY LPC

MEDICARE: LARRY G GRIGSBY 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
1101YM0800XMental Health CounselorC.1800971OH

General Provider Information

NPI Number : 1891293346
Entity Type Code : Individual
Provider Name (Legal Business Name) : LARRY G GRIGSBY LPC
Provider Business Mailing Address
First Line : 1201 FAIRINGTON DR
Second Line :
City : SIDNEY
State : OH
Zip : 45365-8144
Country : US
Telephone Number : 937-498-4593
Fax Number :
Provider Business Practice Location Address
First Line : 1201 FAIRINGTON DR
Second Line :
City : SIDNEY
State : OH
Zip : 45365-8144
Country : US
Telephone Number : 937-498-4593
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2018
Last Update Date : 01/30/2018

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Directions to “ LARRY G GRIGSBY LPC” Practice Location

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