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General NPI Number Information
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NPI Number | 1467731018
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Entity Type | Individual
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Provider Name | THERESA ANNE GRIFFITH LPC
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Gender | Female
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Dates
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Enumeration Date | 08/14/2011
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Last Update Date | 11/08/2018
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Provider Practice Location Address
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Address Line | 1059 BARTON DR
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City | FORDLAND
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State | MO
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Zip | 65652-7350
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Country | US
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Telephone | 417-767-2273
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Fax | 417-767-4054
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Provider Business Mailing Address
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Address Line | 414 BAILIWICK DR
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City | ROGERSVILLE
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State | MO
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Zip | 65742-9750
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Country | US
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Telephone | 417-718-0771
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2011024836
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License Number State | MO
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