Provider Demographics
NPI:1881104743
Name:GRISARD, EDLA (MS MFT)
Entity type:Individual
Prefix:
First Name:EDLA
Middle Name:
Last Name:GRISARD
Suffix:
Gender:F
Credentials:MS MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3760 BIRD RD UNIT 216
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33146-1551
Mailing Address - Country:US
Mailing Address - Phone:786-521-3816
Mailing Address - Fax:
Practice Address - Street 1:700 S ROYAL POINCIANA BLVD STE 300
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-6667
Practice Address - Country:US
Practice Address - Phone:305-668-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor