Provider Demographics
NPI:1851554729
Name:GRIGSBY, MICHELLE LINN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LINN
Last Name:GRIGSBY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16418 DURANGO CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-4425
Mailing Address - Country:US
Mailing Address - Phone:210-683-5975
Mailing Address - Fax:210-714-3690
Practice Address - Street 1:16170 JONES MALTSBERGER RD STE 202
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-3204
Practice Address - Country:US
Practice Address - Phone:210-683-5975
Practice Address - Fax:210-714-3690
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34762103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0285249-06Medicaid
TX215695747OtherUNITED BEHAVIORAL HEALTH
TX263982000OtherMAGELLAN HEALTH SERVICES