MEDICARE: CHEYENNE GRIFFIN MS

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1912668674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHEYENNE GRIFFIN MS

Provider Business Mailing Address
First Line	:	5104 SEALANDS LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-8416
Country	:	US
Telephone Number	:	682-478-5992
Fax Number	:

Provider Business Practice Location Address
First Line	:	6221 CHAPEL HILL BLVD STE 100
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-6392
Country	:	US
Telephone Number	:	214-549-5280
Fax Number	:

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

Provider Enumeration Date	:	01/05/2022
Last Update Date	:	01/05/2022

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