Provider Demographics
NPI:1437387859
Name:GRINNELL, LACEY ERIN (MS)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:ERIN
Last Name:GRINNELL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5332 S MEMORIAL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-9000
Mailing Address - Country:US
Mailing Address - Phone:918-895-8044
Mailing Address - Fax:918-895-8056
Practice Address - Street 1:5332 S MEMORIAL DR STE 300
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-9000
Practice Address - Country:US
Practice Address - Phone:918-895-8044
Practice Address - Fax:918-895-8056
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OK4793101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator