Provider Demographics
NPI:1821173824
Name:GRIZZLE, MAUREEN E (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:E
Last Name:GRIZZLE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7606 S QUEBEC AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-8101
Mailing Address - Country:US
Mailing Address - Phone:918-496-3310
Mailing Address - Fax:918-496-3310
Practice Address - Street 1:2140 S HARVARD AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-1960
Practice Address - Country:US
Practice Address - Phone:918-747-6377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
OK990106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist