Provider Demographics
NPI:1033280359
Name:L C GRISSOM AND ASSOCIATES PLLC
Entity Type:Organization
Organization Name:L C GRISSOM AND ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:GRISSOM
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:480-775-8811
Mailing Address - Street 1:1600 W CHANDLER BLVD
Mailing Address - Street 2:STE. 250
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6153
Mailing Address - Country:US
Mailing Address - Phone:480-775-8811
Mailing Address - Fax:480-775-8866
Practice Address - Street 1:1600 W CHANDLER BLVD
Practice Address - Street 2:STE. 250
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6153
Practice Address - Country:US
Practice Address - Phone:480-775-8811
Practice Address - Fax:480-775-8866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN030340363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty