Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TR0400X | Rehabilitation Psychologist | ||
Y | 1041C0700X | Clinical Social Worker | 64493 | TX |
NPI | 1568735280 |
---|---|
Provider Name | Amber Griffin |
First Address | Mesquite, TX 75149-1955 |
Second Address | Mesquite, TX 75149-1955 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2012 |
Last Update Date | 04/08/2021 |