MEDICARE: MS. IVY CLAIRE GRIFFIN MA, LMFT

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	106H00000X	Marriage & Family Therapist	MFC51714	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	55	OTHER	CA	MEDI-CAL/LPHA

General Provider Information

NPI Number	:	1588817985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. IVY CLAIRE GRIFFIN MA, LMFT

Provider Business Mailing Address
First Line	:	1614 X ST
Second Line	:	SUITE A
City	:	SACRAMENTO
State	:	CA
Zip	:	95818-2300
Country	:	US
Telephone Number	:	916-287-3430
Fax Number	:

Provider Business Practice Location Address
First Line	:	1614 X ST
Second Line	:	SUITE A
City	:	SACRAMENTO
State	:	CA
Zip	:	95818-2300
Country	:	US
Telephone Number	:	916-287-3430
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2008
Last Update Date	:	02/22/2017

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