Provider Demographics
NPI:1194269779
Name:GRIGGS, MURANDA (MS, LPC, CDCI, MAC)
Entity type:Individual
Prefix:
First Name:MURANDA
Middle Name:
Last Name:GRIGGS
Suffix:
Gender:F
Credentials:MS, LPC, CDCI, MAC
Other - Prefix:
Other - First Name:MURANDA
Other - Middle Name:
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16600 CENTERFIELD DR
Mailing Address - Street 2:STE 201
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7702
Mailing Address - Country:US
Mailing Address - Phone:425-941-6419
Mailing Address - Fax:
Practice Address - Street 1:16600 CENTERFIELD DR
Practice Address - Street 2:STE 201
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7702
Practice Address - Country:US
Practice Address - Phone:425-941-6419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4092101YA0400X
AK116225101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)