Provider Demographics
NPI:1417338310
Name:GRISSOM, CHRISTY L (LPC)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:L
Last Name:GRISSOM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17478 CLEARWATER WAY
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-7370
Mailing Address - Country:US
Mailing Address - Phone:660-341-4882
Mailing Address - Fax:
Practice Address - Street 1:803 S BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-4025
Practice Address - Country:US
Practice Address - Phone:660-341-4882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001018054101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional