Provider Demographics
NPI:1104345040
Name:ALANIZ, GRISELDA ANN (LPC, LCDC)
Entity type:Individual
Prefix:
First Name:GRISELDA
Middle Name:ANN
Last Name:ALANIZ
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 W OCEAN BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:LOS FRESNOS
Mailing Address - State:TX
Mailing Address - Zip Code:78566-3669
Mailing Address - Country:US
Mailing Address - Phone:956-278-0021
Mailing Address - Fax:800-211-3351
Practice Address - Street 1:324 W OCEAN BLVD STE 203
Practice Address - Street 2:
Practice Address - City:LOS FRESNOS
Practice Address - State:TX
Practice Address - Zip Code:78566-3669
Practice Address - Country:US
Practice Address - Phone:956-278-0021
Practice Address - Fax:800-211-3351
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14003101YA0400X
TX77477101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX413564201Medicaid