Provider Demographics
NPI:1881020758
Name:GRISSOM, MARTA JO (LMHC)
Entity type:Individual
Prefix:
First Name:MARTA
Middle Name:JO
Last Name:GRISSOM
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 M ST NE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-4430
Mailing Address - Country:US
Mailing Address - Phone:253-831-6222
Mailing Address - Fax:253-887-7620
Practice Address - Street 1:105 M ST NE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4430
Practice Address - Country:US
Practice Address - Phone:253-831-6222
Practice Address - Fax:253-887-7620
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2025-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60402671101YM0800X
WACP60472466101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)