Provider Demographics
NPI:1982858866
Name:GRIZZLE, JONHENRY (PHD)
Entity Type:Individual
Prefix:DR
First Name:JONHENRY
Middle Name:
Last Name:GRIZZLE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8207 EAGLE PEAK
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4350
Mailing Address - Country:US
Mailing Address - Phone:210-323-5094
Mailing Address - Fax:
Practice Address - Street 1:3851 ROGER BROOKE DRIVE MCHE-QD (CREDS)
Practice Address - Street 2:BROOKE ARMY MEDICAL CENTER
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-6200
Practice Address - Country:US
Practice Address - Phone:210-916-2460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLD1748103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical