Provider Demographics
NPI:1023045457
Name:GRIFFIN-CLARK, NORA JANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:NORA
Middle Name:JANE
Last Name:GRIFFIN-CLARK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 HEARTLAND RD STE 3800
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-6201
Mailing Address - Country:US
Mailing Address - Phone:816-671-4812
Mailing Address - Fax:
Practice Address - Street 1:901 HEARTLAND RD
Practice Address - Street 2:SUITE 3800
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-6200
Practice Address - Country:US
Practice Address - Phone:816-671-4837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPYR0231103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0006755AMedicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST