Provider Demographics
NPI:1003468521
Name:GRIFFIN, DANIEL JAMES (LCSW)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JAMES
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-5909
Mailing Address - Country:US
Mailing Address - Phone:208-219-6304
Mailing Address - Fax:
Practice Address - Street 1:1070 RIVERWALK DR STE 258
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-3343
Practice Address - Country:US
Practice Address - Phone:208-219-7655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2023-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-424901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical