Provider Demographics
NPI:1093352072
Name:GRIZZLE, SCOTT (LPC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:GRIZZLE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4024 CHAPEL QUARTERS
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75707-5483
Mailing Address - Country:US
Mailing Address - Phone:903-576-9003
Mailing Address - Fax:
Practice Address - Street 1:3800 PALUXY DR STE 431
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1659
Practice Address - Country:US
Practice Address - Phone:903-576-9003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78527101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional