Provider Demographics
NPI:1760624654
Name:GRIJALVA, ATHENA FELICIA (MA, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ATHENA
Middle Name:FELICIA
Last Name:GRIJALVA
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7133 RADIUS LOOP SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98513-5140
Mailing Address - Country:US
Mailing Address - Phone:360-259-4223
Mailing Address - Fax:
Practice Address - Street 1:2217 CAPITOL WAY S
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-2830
Practice Address - Country:US
Practice Address - Phone:360-259-4223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF 00001986106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist