Healthcare Provider Details

I. General information

NPI: 1629972666
Provider Name (Legal Business Name): TERRELL GRIFFIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5807 W MAPLE RD STE 171
WEST BLOOMFIELD MI
48322-4483
US

IV. Provider business mailing address

6877 ARLENE CT
ROMULUS MI
48174-4020
US

V. Phone/Fax

Practice location:
  • Phone: 248-633-8576
  • Fax:
Mailing address:
  • Phone: 313-799-5792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704375746
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: