MEDICARE: MR. MICHAEL ROY GRIFFITH MFT

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	106H00000X	Marriage & Family Therapist	MFT28859	CA
2	122300000X	Dentist	20867	CA

General Provider Information

NPI Number	:	1144379132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL ROY GRIFFITH MFT

Provider Business Mailing Address
First Line	:	870 MARKET ST
Second Line	:	#1045
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94102-3099
Country	:	US
Telephone Number	:	415-546-6548
Fax Number	:	415-824-0748

Provider Business Practice Location Address
First Line	:	870 MARKET ST
Second Line	:	STE 1045
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94102-3099
Country	:	US
Telephone Number	:	415-546-6548
Fax Number	:	415-824-0748

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	03/15/2016

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