Healthcare Provider Details

I. General information

NPI: 1336678952
Provider Name (Legal Business Name): GRIFFIN & ASSOCIATED PRACTITIONERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 CLUB RD STE 350
EUGENE OR
97401-2463
US

IV. Provider business mailing address

66 CLUB RD STE 350
EUGENE OR
97401-2463
US

V. Phone/Fax

Practice location:
  • Phone: 541-343-1728
  • Fax: 541-485-0052
Mailing address:
  • Phone: 541-343-1728
  • Fax: 541-485-0052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC2751
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LISA GRIFFIN
Title or Position: OWNER
Credential:
Phone: 541-654-0533