Provider Demographics
NPI:1063283729
Name:GRIGORENKO, ELENA L
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:L
Last Name:GRIGORENKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4349 MARTIN LUTHER KING BLVD RM 373
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77204-3074
Mailing Address - Country:US
Mailing Address - Phone:713-743-0595
Mailing Address - Fax:
Practice Address - Street 1:4349 MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77204-3074
Practice Address - Country:US
Practice Address - Phone:713-743-0595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37996103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist