Edie Diane Grizzle, LPC, LMAC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

2397 Issued in KS

Practice address

210 W 21St St
Concordia, KS 66901-5200

Phone

(785) 243-8900

Fax

(785) 243-8933

NPI assigned

May 21, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Community Pathways Unlimited Inc

  • Clinical Psychologist
  • Oklahoma City, OK
  • NPI 1659328284
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1337558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599696000000",
    "number": "1841550183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 N WASHINGTON ST",
            "city": "JUNCTION CITY",
            "state": "KS",
            "postal_code": "664413686",
            "telephone_number": "785-236-1178",
            "fax_number": "785-579-5456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 W 21ST ST",
            "city": "CONCORDIA",
            "state": "KS",
            "postal_code": "669015200",
            "telephone_number": "785-243-8900",
            "fax_number": "785-243-8933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRIZZLE",
        "first_name": "EDIE",
        "middle_name": "DIANE",
        "name_prefix": "Mrs.",
        "credential": "LPC, LMAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-05-21",
        "last_updated": "2020-09-10",
        "certification_date": "2020-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "KS",
            "license": "020",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "KS",
            "license": "2397",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Colby Nicholas Jack Garrison
• Mandy M Gerstner, LMSW
• Melissa Gilsdorf, PA-C
• Kelci Marie Glover, OD
• Lauri Ann Goheen, LMSW
• Sara M Hake, PMHNP
• Albert H Hartman, OTR
• Gregory Lynn Hattan, D.D.S.
• Brynne E Haverkamp, LSCSW, LMAC
• Kayla Hood

• Professional Counselor in Concordia, KS
• Providers in Concordia, KS by specialty
• Professional Counselor in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.