MEDICARE: DOUGLAS SPENCER GRIFFIN LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	2017029899	MO

General Provider Information

NPI Number	:	1134743750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS SPENCER GRIFFIN LPC

Provider Business Mailing Address
First Line	:	7271 GAYOLA PL
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63143-2317
Country	:	US
Telephone Number	:	573-380-2573
Fax Number	:

Provider Business Practice Location Address
First Line	:	1715 DEER TRACKS TRL STE 260
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-1855
Country	:	US
Telephone Number	:	314-884-0715
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2020
Last Update Date	:	05/29/2020

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