Provider Demographics
NPI:1073260410
Name:GRISWOLD, TIMOTHY ALLE
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ALLE
Last Name:GRISWOLD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27121 174TH PL SE STE 101
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-4939
Mailing Address - Country:US
Mailing Address - Phone:253-867-4495
Mailing Address - Fax:253-867-8756
Practice Address - Street 1:27121 174TH PL SE STE 101
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-4939
Practice Address - Country:US
Practice Address - Phone:253-867-4495
Practice Address - Fax:253-867-8756
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-06
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health