Provider Demographics
NPI:1518000777
Name:GRIZ, LU
Entity Type:Individual
Prefix:DR
First Name:LU
Middle Name:
Last Name:GRIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2890 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-4462
Mailing Address - Country:US
Mailing Address - Phone:904-277-5600
Mailing Address - Fax:904-277-0022
Practice Address - Street 1:2890 S 8TH ST
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-4462
Practice Address - Country:US
Practice Address - Phone:904-277-5600
Practice Address - Fax:904-277-0022
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8084103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical