Healthcare Provider Details

I. General information

NPI: 1083825871
Provider Name (Legal Business Name): LAURA GREEN GRIFFIN MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23621 MAIN ST
CARSON CA
90745-5743
US

IV. Provider business mailing address

19 SEAVIEW DR N
ROLLING HILLS ESTATES CA
90274-5752
US

V. Phone/Fax

Practice location:
  • Phone: 310-816-5361
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT22929
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: