Provider Demographics
NPI:1598821654
Name:GRIESINGER, VICTORIA COOK (PHD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:COOK
Last Name:GRIESINGER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:LYNNE
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1517 NICHOLASVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1429
Mailing Address - Country:US
Mailing Address - Phone:859-312-7255
Mailing Address - Fax:859-278-1844
Practice Address - Street 1:1517 NICHOLASVILLE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1429
Practice Address - Country:US
Practice Address - Phone:859-312-7255
Practice Address - Fax:859-278-1844
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY916103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY916OtherLICENSE
KY77-0648894OtherTAX ID
KY11547612OtherCAQH
KYK008632OtherTRICARE
KY77-0648894OtherTAX ID
KYR17599Medicare UPIN