Provider Demographics
NPI:1255095337
Name:GRINDSTAFF, STEVEN B
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:B
Last Name:GRINDSTAFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 TERRACE ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-6588
Mailing Address - Country:US
Mailing Address - Phone:423-345-8285
Mailing Address - Fax:
Practice Address - Street 1:2305 N GATEWAY AVE UNIT 4
Practice Address - Street 2:
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-8683
Practice Address - Country:US
Practice Address - Phone:452-213-4882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7766101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health