Provider Demographics
NPI:1699964304
Name:ESCOBEDO, GRISELDA P (LPC)
Entity type:Individual
Prefix:MRS
First Name:GRISELDA
Middle Name:P
Last Name:ESCOBEDO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 4TH AVE E
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-6312
Mailing Address - Country:US
Mailing Address - Phone:208-736-0695
Mailing Address - Fax:208-735-2482
Practice Address - Street 1:220 4TH AVE E
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6312
Practice Address - Country:US
Practice Address - Phone:208-736-0695
Practice Address - Fax:208-735-2482
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-3569101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health