Provider Demographics
NPI:1134466550
Name:GRIJALVA, LINDSAY WILSON (MS, MFT)
Entity Type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:WILSON
Last Name:GRIJALVA
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5405 ALTON PKWY
Mailing Address - Street 2:STE 5A #534
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-3717
Mailing Address - Country:US
Mailing Address - Phone:949-233-0413
Mailing Address - Fax:
Practice Address - Street 1:5405 ALTON PKWY
Practice Address - Street 2:STE 5A #534
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-3717
Practice Address - Country:US
Practice Address - Phone:949-233-0413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 51164106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist