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General NPI Number Information
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NPI Number | 1699318659
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Entity Type | Organization
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Legal Business Name | KGH PSYCHOLOGY PRACTICE LLC
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Dates
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Enumeration Date | 10/22/2019
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Last Update Date | 12/03/2019
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Provider Practice Location Address
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Address Line | 403 COVENTRY DR
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City | PHILLIPSBURG
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State | NJ
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Zip | 08865-1969
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Country | US
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Telephone | 908-386-2100
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Fax | 908-386-2200
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Provider Business Mailing Address
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Address Line | 403 COVENTRY DR
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City | PHILLIPSBURG
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State | NJ
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Zip | 08865-1969
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Country | US
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Telephone | 908-386-2100
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Fax | 908-386-2200
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. KYNA D GRIFFITH-HENRY
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Credential | PH.D.
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Telephone | 908-386-2100
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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 |
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License Number State |
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