Provider Demographics
NPI:1184718702
Name:GRIESINGER, LAWRENCE EDWARD III (PHD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:EDWARD
Last Name:GRIESINGER
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:TRIPP
Other - Middle Name:
Other - Last Name:GRIESINGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:100 TYLER LANE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:KY
Mailing Address - Zip Code:40336
Mailing Address - Country:US
Mailing Address - Phone:606-723-5128
Mailing Address - Fax:606-723-3328
Practice Address - Street 1:100 TYLER LANE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:KY
Practice Address - Zip Code:40336
Practice Address - Country:US
Practice Address - Phone:606-723-5128
Practice Address - Fax:606-723-3328
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1184103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30615058Medicaid
KY0331617Medicare ID - Type Unspecified