Provider Demographics
NPI:1003220617
Name:GRIFFITH, JAY ROLAND (IMFT)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:ROLAND
Last Name:GRIFFITH
Suffix:
Gender:M
Credentials:IMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 536
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-0536
Mailing Address - Country:US
Mailing Address - Phone:740-877-4157
Mailing Address - Fax:740-587-1362
Practice Address - Street 1:317 S MAIN ST
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:IN
Practice Address - Zip Code:46989-9358
Practice Address - Country:US
Practice Address - Phone:740-877-4157
Practice Address - Fax:740-344-2651
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF.1400008106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0156410Medicaid
OH9226891Medicare PIN