Healthcare Provider Details

I. General information

NPI: 1417657586
Provider Name (Legal Business Name): JAMIE L GRIFFITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JAMIE LOPEZ

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4723 FOX GLEN AVE
LA VERNE CA
91750-1839
US

IV. Provider business mailing address

301 E ARROW HWY STE 101
SAN DIMAS CA
91773-3364
US

V. Phone/Fax

Practice location:
  • Phone: 909-526-0349
  • Fax:
Mailing address:
  • Phone: 909-526-0349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number21291
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: