Provider Demographics
NPI:1700114873
Name:GRISSOM, ANGELA KAY (CASE MANAGER II)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:KAY
Last Name:GRISSOM
Suffix:
Gender:F
Credentials:CASE MANAGER II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28232 S 547 RD
Mailing Address - Street 2:
Mailing Address - City:PARK HILL
Mailing Address - State:OK
Mailing Address - Zip Code:74451-2866
Mailing Address - Country:US
Mailing Address - Phone:918-570-9246
Mailing Address - Fax:
Practice Address - Street 1:6712 E 480
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:OK
Practice Address - Zip Code:74365-2762
Practice Address - Country:US
Practice Address - Phone:918-434-5197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-30
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor