Provider Demographics
NPI:1770757585
Name:GREVING, KARISSA (PHD)
Entity type:Individual
Prefix:DR
First Name:KARISSA
Middle Name:
Last Name:GREVING
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 S MILL AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-6736
Mailing Address - Country:US
Mailing Address - Phone:602-577-8620
Mailing Address - Fax:
Practice Address - Street 1:4700 S MILL AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-6736
Practice Address - Country:US
Practice Address - Phone:602-577-8620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10270106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist