Provider Demographics
NPI:1013156256
Name:GRIGSBY, NISHANI KWELI (LPC)
Entity Type:Individual
Prefix:MRS
First Name:NISHANI
Middle Name:KWELI
Last Name:GRIGSBY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5108 AZUL LN.
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036
Mailing Address - Country:US
Mailing Address - Phone:817-343-2641
Mailing Address - Fax:817-297-9519
Practice Address - Street 1:3121 COLLINSWORTH
Practice Address - Street 2:SUITE 14
Practice Address - City:FT. WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107
Practice Address - Country:US
Practice Address - Phone:817-343-2641
Practice Address - Fax:817-297-9519
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63440101YP2500X
TX101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX20414501Medicaid