Healthcare Provider Details

I. General information

NPI: 1043092802
Provider Name (Legal Business Name): NATASHA GRIFFIN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2023
Last Update Date: 10/17/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 BOUNDS STREET SUITE L
JACKSON MS
39206
US

IV. Provider business mailing address

PO BOX 151
D LO MS
39062-0151
US

V. Phone/Fax

Practice location:
  • Phone: 769-218-8305
  • Fax:
Mailing address:
  • Phone: 769-218-8305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2890
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: