Healthcare Provider Details

I. General information

NPI: 1689341786
Provider Name (Legal Business Name): TARA D GRIFFITTS QMHS; LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 GRAHAM DR
ATHENS OH
45701-1430
US

IV. Provider business mailing address

1950 MOUNT SAINT MARYS DR
NELSONVILLE OH
45764-1280
US

V. Phone/Fax

Practice location:
  • Phone: 740-541-2764
  • Fax:
Mailing address:
  • Phone: 740-300-0225
  • Fax: 740-594-9967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: