Provider Demographics
NPI:1134171242
Name:CHRISTIE, GRICELDA O (LPC)
Entity type:Individual
Prefix:MS
First Name:GRICELDA
Middle Name:O
Last Name:CHRISTIE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:GRICELDA
Other - Middle Name:O
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:10010 SAN PEDRO AVE
Mailing Address - Street 2:# 610
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-3862
Mailing Address - Country:US
Mailing Address - Phone:210-231-6454
Mailing Address - Fax:210-222-8030
Practice Address - Street 1:10010 SAN PEDRO AVE
Practice Address - Street 2:# 610
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-3862
Practice Address - Country:US
Practice Address - Phone:210-231-6454
Practice Address - Fax:210-222-8030
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13193101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX026933403Medicaid
TX026933406Medicaid
TX026933402Medicaid