MEDICARE: LATOYIA GRIFFIN LCSW CGP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	NV2011328160	NV

General Provider Information

NPI Number	:	1285900241
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LATOYIA GRIFFIN LCSW CGP LLC

Provider Business Mailing Address
First Line	:	PO BOX 82251
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89180-2251
Country	:	US
Telephone Number	:	702-485-0430
Fax Number	:

Provider Business Practice Location Address
First Line	:	5145 S DURANGO DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-0191
Country	:	US
Telephone Number	:	702-485-0430
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	LATOYIA GRIFFIN
Credential	:	LCSW
Telephone Number	:	702-485-0430

Provider Enumeration Date	:	03/23/2012
Last Update Date	:	03/23/2012

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