Provider Demographics
NPI:1013798479
Name:GRIESINGER, CHARLY E (LMSW)
Entity Type:Individual
Prefix:
First Name:CHARLY
Middle Name:E
Last Name:GRIESINGER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CHARLY
Other - Middle Name:E
Other - Last Name:BATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2885 W BATTLEFIELD ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-3952
Mailing Address - Country:US
Mailing Address - Phone:417-761-5214
Mailing Address - Fax:
Practice Address - Street 1:1350 SPUR DR STE 230
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MO
Practice Address - Zip Code:65706-2196
Practice Address - Country:US
Practice Address - Phone:417-761-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20230330181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical