Provider Demographics
NPI:1740659903
Name:GRINDSTAFF, ALICIA M (LPC)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:M
Last Name:GRINDSTAFF
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:M
Other - Last Name:GROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:529 SE 2ND ST STE A
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-2654
Mailing Address - Country:US
Mailing Address - Phone:816-479-0205
Mailing Address - Fax:816-479-0205
Practice Address - Street 1:529 SE 2ND ST STE A
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-2654
Practice Address - Country:US
Practice Address - Phone:816-479-0205
Practice Address - Fax:816-479-0205
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-17
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015040561101Y00000X, 101YP2500X, 101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor