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General NPI Number Information
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NPI Number | 1639688724
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Entity Type | Organization
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Legal Business Name | NOVA M. GRIFFITH, PH.D., PSYCHOLOGICAL SERVICES LLC
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Dates
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Enumeration Date | 09/21/2017
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Last Update Date | 02/05/2021
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Provider Practice Location Address
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Address Line | 121 N 13TH ST STE 2
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City | HERRIN
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State | IL
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Zip | 62948-3255
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Country | US
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Telephone | 618-969-2922
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Fax |
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Provider Business Mailing Address
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Address Line | 400 E 8TH ST
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City | JOHNSTON CITY
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State | IL
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Zip | 62951-1539
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Country | US
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Telephone | 618-696-2922
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Fax |
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Authorized Official
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Title or Position | OWNER,LIC. CLINICAL PSYCHOLOGIST
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Name | DR. NOVA M GRIFFITH
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Credential | PH.D.
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Telephone | 618-969-2922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071007669
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License Number State | IL
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