Provider Demographics
NPI:1881571297
Name:GRISAFE-PONT, CHRIS
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:GRISAFE-PONT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5319 W 119TH TER APT 116
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-3173
Mailing Address - Country:US
Mailing Address - Phone:816-838-9367
Mailing Address - Fax:
Practice Address - Street 1:10777 BARKLEY ST STE 120
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1162
Practice Address - Country:US
Practice Address - Phone:913-204-0582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03442-T.103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical