Basic Information
| Provider Information | |||||||||
| NPI: | 1225655129 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRIGSBY | ||||||||
| FirstName: | LATISHA | ||||||||
| MiddleName: | AYELY | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSW, ASW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24275 JEFFERSON AVE | ||||||||
| Address2: | |||||||||
| City: | MURRIETA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925627285 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516775599 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 24275 JEFFERSON AVE | ||||||||
| Address2: | |||||||||
| City: | MURRIETA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925627285 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516775599 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2020 | ||||||||
| LastUpdateDate: | 11/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | ASW103850 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.