Healthcare Provider Details

I. General information

NPI: 1457719767
Provider Name (Legal Business Name): NARISSA R. GRIFFIN, PH.D., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2016
Last Update Date: 02/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 ROGERS AVE SUITE 201
FORT SMITH AR
72903-3745
US

IV. Provider business mailing address

11417 N HIGHWAY 71
MOUNTAINBURG AR
72946-3641
US

V. Phone/Fax

Practice location:
  • Phone: 479-242-4560
  • Fax: 479-242-4561
Mailing address:
  • Phone: 479-629-4304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number11-21P
License Number StateAR

VIII. Authorized Official

Name: DR. NARISSA R GRIFFIN
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PH.D.
Phone: 479-629-4304