Doctor Name: | DR. KELLY J GRIFFITH |
NPI Number: | 1003856741 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D. |
License Number: | 792 |
Business Practice Address: | 1024 W Lakeridge Ave Stillwater, OK - 740752106 |
Business Phone Number: | 4056128292 |
Business Fax Number: | |
Mailing Address: | 1024 W Lakeridge Ave, STILLWATER |
State: | OK |
Postal Code: | 740752106 |
Phone Number: | 4056128292 |
Fax Number: | |
NPI Enumeration Date: | 06/08/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC2200X |
License Number: | 792 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical Child & Adolescent |
Taxonomy Definition: |