Provider Demographics
NPI:1548398183
Name:GRIEVE, FREDERICK GLENN (PHD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:GLENN
Last Name:GRIEVE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 ALBEMARLE DR
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-1573
Mailing Address - Country:US
Mailing Address - Phone:270-779-8255
Mailing Address - Fax:270-781-7081
Practice Address - Street 1:1215 HIGH ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-2541
Practice Address - Country:US
Practice Address - Phone:270-781-1116
Practice Address - Fax:270-182-9108
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1282103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical