Provider Demographics
NPI:1558421271
Name:GRINDLE, ELAINE E (PAT #-028)
Entity type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:E
Last Name:GRINDLE
Suffix:
Gender:F
Credentials:PAT #-028
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:SOUTHWESTERN COUNSELING SERVICES
Mailing Address - Street 2:2300 FOOTHILL BLVD
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901
Mailing Address - Country:US
Mailing Address - Phone:307-352-6677
Mailing Address - Fax:307-352-6614
Practice Address - Street 1:SOUTHWEST COUNSELING SERVICES
Practice Address - Street 2:2300 FOOTHILL BLVD
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901
Practice Address - Country:US
Practice Address - Phone:307-352-6677
Practice Address - Fax:307-352-6614
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYP.A.T.-028101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)