Provider Demographics
NPI:1174634752
Name:GRIGGS, KIRSTEN LEE (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:LEE
Last Name:GRIGGS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 420
Mailing Address - Street 2:
Mailing Address - City:SUGAR CITY
Mailing Address - State:ID
Mailing Address - Zip Code:83448-0420
Mailing Address - Country:US
Mailing Address - Phone:208-390-4122
Mailing Address - Fax:208-359-1125
Practice Address - Street 1:310 N 2ND E STE 114
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-1606
Practice Address - Country:US
Practice Address - Phone:208-359-0581
Practice Address - Fax:208-359-1125
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-371101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010156968OtherBLUE SHIELD OF IDAHO
IDQ7359OtherBLUE CROSS