MEDICARE: DR. BRANDON J GRIFFIN PHD

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	103TC0700X	Clinical Psychologist	19-08P	AR

General Provider Information

NPI Number	:	1255973350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRANDON J GRIFFIN PHD

Provider Business Mailing Address
First Line	:	4281 HIGHWAY 201 S
Second Line	:
City	:	MOUNTAIN HOME
State	:	AR
Zip	:	72653-5543
Country	:	US
Telephone Number	:	870-405-0558
Fax Number	:

Provider Business Practice Location Address
First Line	:	2117 COMMERCE ST
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72206-2321
Country	:	US
Telephone Number	:	870-405-0558
Fax Number	:

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

Provider Enumeration Date	:	10/10/2019
Last Update Date	:	06/26/2023

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