MEDICARE: LATOYIA GRIFFIN, LLC

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	1041C0700X	Clinical Social Worker	5085-C	NV

General Provider Information

NPI Number	:	1427429224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LATOYIA GRIFFIN, LLC

Provider Business Mailing Address
First Line	:	PO BOX 82251
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89180-2251
Country	:	US
Telephone Number	:	702-485-0430
Fax Number	:

Provider Business Practice Location Address
First Line	:	6069 S FORT APACHE RD
Second Line	:	SUITE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5647
Country	:	US
Telephone Number	:	702-485-0430
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	LATOYIA K PIPER
Credential	:	LCSW, CGP
Telephone Number	:	702-485-0430

Provider Enumeration Date	:	10/19/2015
Last Update Date	:	10/19/2015

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