Provider Demographics
NPI:1700088457
Name:GRISWOLD, KRISTEEN K (LCPC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEEN
Middle Name:K
Last Name:GRISWOLD
Suffix:
Gender:F
Credentials:LCPC, LPC
Other - Prefix:
Other - First Name:KRISTEEN
Other - Middle Name:K
Other - Last Name:DOWNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC, LPC
Mailing Address - Street 1:15 ASHER LN
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64089-8572
Mailing Address - Country:US
Mailing Address - Phone:816-866-0169
Mailing Address - Fax:
Practice Address - Street 1:15 ASHER LN
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:MO
Practice Address - Zip Code:64089-8572
Practice Address - Country:US
Practice Address - Phone:816-866-0169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005038691101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO497598300Medicaid