Active NPI
Gayla Kay Grisham, LBSW
- Case Manager/Care Coordinator
- Waco, TX
National Provider Identifier
1114058245
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- License
- 33966
- Practice address
- 421 Villa Drive #209
Waco, TX 76710 - Phone
- (254) 405-2702
- Fax
- (866) 686-9651
- NPI assigned
- Mar 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 33966 | TX | |
| Case Manager/Care Coordinator | 171M00000X | 33966 | TX | Primary |
| Case Management Agency | 251B00000X | 33966 | TX |
Addresses
Primary practice location
421 Villa Drive #209
Waco, TX 76710
Mailing address
421 Villa Drive #209
Waco, TX 76710
Phone (254) 405-2702
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 182405401 | Medicaid | TX | |
| 182404701 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 33966 | TX | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Social Work Connection | Case Management | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Case Management Agency
- Waco, TX
- NPI 1821294349
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184889600000",
"number": "1114058245",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "421 VILLA DRIVE #209",
"city": "WACO",
"state": "TX",
"postal_code": "76710",
"telephone_number": "254-405-2702",
"fax_number": "866-686-9651"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "421 VILLA DRIVE #209",
"city": "WACO",
"state": "TX",
"postal_code": "76710",
"telephone_number": "254-405-2702",
"fax_number": "866-686-9651"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRISHAM",
"first_name": "GAYLA",
"middle_name": "KAY",
"name_prefix": "Ms.",
"credential": "LBSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-08",
"last_updated": "2007-07-20",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TX",
"license": "33966",
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "TX",
"license": "33966",
"primary": true
},
{
"code": "251B00000X",
"taxonomy_group": "",
"desc": "Case Management",
"state": "TX",
"license": "33966",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "182405401",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "182404701",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waco, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.