Provider Demographics
NPI:1134699150
Name:GRISSETT, DAYSHA LATAY
Entity Type:Individual
Prefix:
First Name:DAYSHA
Middle Name:LATAY
Last Name:GRISSETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 FREEMAN RD E STE 1
Mailing Address - Street 2:
Mailing Address - City:FIFE
Mailing Address - State:WA
Mailing Address - Zip Code:98424-3776
Mailing Address - Country:US
Mailing Address - Phone:253-922-7833
Mailing Address - Fax:253-922-7611
Practice Address - Street 1:2150 FREEMAN RD E STE 1
Practice Address - Street 2:
Practice Address - City:FIFE
Practice Address - State:WA
Practice Address - Zip Code:98424-3776
Practice Address - Country:US
Practice Address - Phone:253-922-7833
Practice Address - Fax:253-922-7611
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60811469101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health