Provider Demographics
NPI:1639651730
Name:GRILE, CAROLYN MATTHEWS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:MATTHEWS
Last Name:GRILE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MRS
Other - First Name:CAROLYN
Other - Middle Name:
Other - Last Name:MATTHEWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYM
Mailing Address - Street 1:985450 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-5450
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6902 PINE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-2855
Practice Address - Country:US
Practice Address - Phone:402-559-2568
Practice Address - Fax:402-559-5737
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12960101YM0800X
NE721101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health