Provider Demographics
NPI:1770621955
Name:GRISSOM, STEPHANIE ANNETTE (MA, LPC-MHSP)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ANNETTE
Last Name:GRISSOM
Suffix:
Gender:F
Credentials:MA, LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 COURTLAND DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-5279
Mailing Address - Country:US
Mailing Address - Phone:615-969-9885
Mailing Address - Fax:
Practice Address - Street 1:9025 OVERLOOK BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-2710
Practice Address - Country:US
Practice Address - Phone:615-969-9885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN02189101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health