Healthcare Provider Details

I. General information

NPI: 1336044619
Provider Name (Legal Business Name): DARIUS ROBERT JUNGFERMAN-GRIFFIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 13TH ST SE
PUYALLUP WA
98372-4707
US

IV. Provider business mailing address

12743 LALA COVE LN SE
OLALLA WA
98359-9615
US

V. Phone/Fax

Practice location:
  • Phone: 253-848-0880
  • Fax:
Mailing address:
  • Phone: 360-441-2929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: