Healthcare Provider Details

I. General information

NPI: 1780293522
Provider Name (Legal Business Name): INGRID GRIFFIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 W MISSION LN
PHOENIX AZ
85021-2832
US

IV. Provider business mailing address

2220 W MISSION LN
PHOENIX AZ
85021-2832
US

V. Phone/Fax

Practice location:
  • Phone: 615-240-0768
  • Fax:
Mailing address:
  • Phone: 615-240-0768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: