Healthcare Provider Details

I. General information

NPI: 1912204835
Provider Name (Legal Business Name): ANNETTE KATHARINE GRIFFITH PH.D, BCBA-D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2011
Last Update Date: 11/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 N COURT AVE SUITE #15
COLBY KS
67701-2424
US

IV. Provider business mailing address

535 N COURT AVE SUITE #15
COLBY KS
67701-2424
US

V. Phone/Fax

Practice location:
  • Phone: 785-626-2369
  • Fax:
Mailing address:
  • Phone: 785-626-2369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2011003585
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: