Provider Demographics
NPI:1427730373
Name:GRISSELL, DREW LANI
Entity type:Individual
Prefix:
First Name:DREW
Middle Name:LANI
Last Name:GRISSELL
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 1:3310 ORANGE RD
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-4942
Mailing Address - Country:US
Mailing Address - Phone:541-515-5267
Mailing Address - Fax:
Practice Address - Street 1:2571 N TOLEDO BLADE BLVD UNIT 2
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34289-9351
Practice Address - Country:US
Practice Address - Phone:941-800-2396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH24000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health