Provider Demographics
NPI:1013554211
Name:GRIGGS, LISA A (MS, LPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:GRIGGS
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:A
Other - Last Name:SUTTERFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2507 BARCELONA AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-2103
Mailing Address - Country:US
Mailing Address - Phone:479-530-6077
Mailing Address - Fax:
Practice Address - Street 1:2103 S 54TH ST STE 2
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8126
Practice Address - Country:US
Practice Address - Phone:479-372-7446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-06
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP2208001101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR240811795Medicaid