MEDICARE: MS. MARY BETH GRIFFIS M.A.

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	101Y00000X	Counselor	MH 8742	FL
2	101YM0800X	Mental Health Counselor	MH 8742	FL
3	101YP2500X	Professional Counselor	MH 8742	FL

General Provider Information

NPI Number	:	1528247616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY BETH GRIFFIS M.A.

Provider Business Mailing Address
First Line	:	3317 ATHENA DR
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-2008
Country	:	US
Telephone Number	:	407-782-0134
Fax Number	:

Provider Business Practice Location Address
First Line	:	5458 LAKE HOWELL RD
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-1034
Country	:	US
Telephone Number	:	407-782-0134
Fax Number	:

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

Provider Enumeration Date	:	10/25/2007
Last Update Date	:	05/07/2015

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