Provider Demographics
NPI:1114190832
Name:GRINDSTAFF, JASON (PHD, LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:GRINDSTAFF
Suffix:
Gender:M
Credentials:PHD, LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 ARMSTRONG PL APT B
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37090-4085
Mailing Address - Country:US
Mailing Address - Phone:615-939-1190
Mailing Address - Fax:
Practice Address - Street 1:905 ARMSTRONG PL APT B
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37090-4085
Practice Address - Country:US
Practice Address - Phone:615-939-1190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-03
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional