Healthcare Provider Details

I. General information

NPI: 1619538675
Provider Name (Legal Business Name): KRISTIN NICOLE GRIFFIS MA, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2019
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

799 E BRANNON RD
NICHOLASVILLE KY
40356-6038
US

IV. Provider business mailing address

109 WIND HAVEN DR
NICHOLASVILLE KY
40356-8010
US

V. Phone/Fax

Practice location:
  • Phone: 606-280-5187
  • Fax: 859-224-4675
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number288239
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-88542
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: