Healthcare Provider Details

I. General information

NPI: 1063684892
Provider Name (Legal Business Name): MICHAEL D. GRIFFITH PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 ELIDA RD STE 2
LIMA OH
45805-1232
US

IV. Provider business mailing address

3000 ELIDA RD STE 2
LIMA OH
45805-1232
US

V. Phone/Fax

Practice location:
  • Phone: 419-225-5238
  • Fax: 419-222-1597
Mailing address:
  • Phone: 419-225-5238
  • Fax: 419-222-1597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number4813
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number4813
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4813
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number4813
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number4813
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number4813
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number4813
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: