Healthcare Provider Details

I. General information

NPI: 1962035709
Provider Name (Legal Business Name): ELLEN M GRIFFIN PSYD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2020
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 N MICHIGAN AVE STE 512
CHICAGO IL
60601-7612
US

IV. Provider business mailing address

155 N MICHIGAN AVE STE 512
CHICAGO IL
60601-7612
US

V. Phone/Fax

Practice location:
  • Phone: 312-787-2726
  • Fax:
Mailing address:
  • Phone: 312-787-2726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ELLEN M GRIFFIN
Title or Position: LICENSED CLINICAL PSYCHOLOGIST
Credential: PSYD
Phone: 312-787-2726