Individual
SUSANNAH BORN-GRISSOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3915 GRAMERCY AVE, NORTH LAS VEGAS, NV 89031-2038
(702) 628-2968
Mailing address
3915 GRAMERCY AVE, NORTH LAS VEGAS, NV 89031-2038
(702) 628-2968
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123456789
—
NV
Enumeration date
07/18/2016
Last updated
07/18/2016
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