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General NPI Number Information
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NPI Number | 1538924766
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Entity Type | Individual
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Provider Name | TRACEY J GRIFFIN ED.D, NCSP
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Gender | Female
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Dates
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Enumeration Date | 02/16/2024
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Last Update Date | 02/16/2024
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Provider Practice Location Address
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Address Line | 116 MAURICE AVE NW
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-4213
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Country | US
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Telephone | 229-237-2960
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Fax |
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Provider Business Mailing Address
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Address Line | 262 RAINBOW DR # 16224
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City | LIVINGSTON
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State | TX
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Zip | 77399-2062
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Country | US
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Telephone | 850-420-0404
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | SS1800
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License Number State | FL
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