Provider Demographics
NPI:1750877866
Name:GRISWOLD, TERI
Entity type:Individual
Prefix:
First Name:TERI
Middle Name:
Last Name:GRISWOLD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TERI
Other - Middle Name:
Other - Last Name:LEONHARDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1957 ARCADIA CT
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906-5415
Mailing Address - Country:US
Mailing Address - Phone:480-825-4032
Mailing Address - Fax:
Practice Address - Street 1:1957 ARCADIA CT
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-5415
Practice Address - Country:US
Practice Address - Phone:480-825-4032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0-19-10391106E00000X
1-21-57093103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst