Provider Demographics
NPI:1144411513
Name:GRISSOM, MAUREEN O'KANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:O'KANE
Last Name:GRISSOM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HEALTH 2, 4349 MARTIN LUTHER KING BLVD SUITE 1001E
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77204-0001
Mailing Address - Country:US
Mailing Address - Phone:713-743-9682
Mailing Address - Fax:713-743-1049
Practice Address - Street 1:HEALTH 2, 4349 MARTIN LUTHER KING BLVD SUITE 1001E
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77204-0001
Practice Address - Country:US
Practice Address - Phone:713-743-9682
Practice Address - Fax:713-743-1049
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006034116103T00000X, 103G00000X
TX38769103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2006034116OtherMO LICENSE
TX38769OtherTEXAS STATE LICENSE