Provider Demographics
NPI:1952404899
Name:GRIGSBY, AMANDA (LPCC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:GRIGSBY
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 790
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-0790
Mailing Address - Country:US
Mailing Address - Phone:606-329-8588
Mailing Address - Fax:606-329-8195
Practice Address - Street 1:840 INTERSTATE DR
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:KY
Practice Address - Zip Code:41143
Practice Address - Country:US
Practice Address - Phone:606-474-5151
Practice Address - Fax:606-475-3219
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY128048101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
JAN 7,2009OtherLIFESYNCH
KY7100283530Medicaid
000000244565OtherANTHEM BCBS
11688454OtherCAQH
JAN 7,2009OtherLIFESYNCH