Provider Demographics
NPI:1841550183
Name:GRIZZLE, EDIE DIANE (LPC, LMAC)
Entity type:Individual
Prefix:MRS
First Name:EDIE
Middle Name:DIANE
Last Name:GRIZZLE
Suffix:
Gender:F
Credentials:LPC, LMAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66441-3686
Mailing Address - Country:US
Mailing Address - Phone:785-236-1178
Mailing Address - Fax:785-579-5456
Practice Address - Street 1:210 W 21ST ST
Practice Address - Street 2:
Practice Address - City:CONCORDIA
Practice Address - State:KS
Practice Address - Zip Code:66901-5200
Practice Address - Country:US
Practice Address - Phone:785-243-8900
Practice Address - Fax:785-243-8933
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS020101YA0400X
KS2397101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)