Provider Demographics
NPI:1043939473
Name:NIELSON-SMITH, GRIFFIN LEIGH (LPC ASSOCIATE, NCC)
Entity Type:Individual
Prefix:
First Name:GRIFFIN
Middle Name:LEIGH
Last Name:NIELSON-SMITH
Suffix:
Gender:F
Credentials:LPC ASSOCIATE, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 N MONTANA AVE UNIT E
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-4879
Mailing Address - Country:US
Mailing Address - Phone:503-489-8757
Mailing Address - Fax:
Practice Address - Street 1:6400 N MONTANA AVE UNIT E
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-4879
Practice Address - Country:US
Practice Address - Phone:503-489-8757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR7796101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health