Provider Demographics
NPI:1477764579
Name:GRIDER, MARY ELAINE (MA, LMHC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELAINE
Last Name:GRIDER
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3935 EAGLE CREEK PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-4690
Mailing Address - Country:US
Mailing Address - Phone:317-293-5563
Mailing Address - Fax:317-293-7478
Practice Address - Street 1:3935 EAGLE CREEK PKWY STE C
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-4690
Practice Address - Country:US
Practice Address - Phone:317-293-5563
Practice Address - Fax:317-293-7478
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001941A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health