Healthcare Provider Details

I. General information

NPI: 1174138085
Provider Name (Legal Business Name): GRIFFIN SAXON LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4443 AMBROSE AVE
LOS ANGELES CA
90027-2114
US

IV. Provider business mailing address

4443 AMBROSE AVE
LOS ANGELES CA
90027-2114
US

V. Phone/Fax

Practice location:
  • Phone: 323-212-5358
  • Fax:
Mailing address:
  • Phone: 323-212-5358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number133407
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number133407
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: