=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013526581
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EARL E. GRIFFITH, PH.D.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2020
-----------------------------------------------------
Last Update Date | 07/30/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 SW 6TH ST
-----------------------------------------------------
City | STUART
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34994-2967
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-283-4437
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 SW 6TH ST
-----------------------------------------------------
City | STUART
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34994-2967
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-283-4437
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. EARL GRIFFITH
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 772-283-4437
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------