Provider Demographics
NPI:1336782291
Name:GRIGGS, LYNZEE LEEANN (BCBA)
Entity Type:Individual
Prefix:
First Name:LYNZEE
Middle Name:LEEANN
Last Name:GRIGGS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7878
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81007-0878
Mailing Address - Country:US
Mailing Address - Phone:719-547-8803
Mailing Address - Fax:719-547-8806
Practice Address - Street 1:125 W PALMER LAKE DR
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-2876
Practice Address - Country:US
Practice Address - Phone:719-547-8803
Practice Address - Fax:719-547-8806
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-19-38170103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst