Provider Demographics
NPI:1063684892
Name:GRIFFITH, MICHAEL D (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:GRIFFITH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 ELIDA RD
Mailing Address - Street 2:STE 2
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-1232
Mailing Address - Country:US
Mailing Address - Phone:419-225-5238
Mailing Address - Fax:419-222-1597
Practice Address - Street 1:3000 ELIDA RD
Practice Address - Street 2:STE 2
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-1232
Practice Address - Country:US
Practice Address - Phone:419-225-5238
Practice Address - Fax:419-222-1597
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4813103TA0700X, 103TB0200X, 103TC0700X, 103TC2200X, 103TF0000X, 103TH0004X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0989864Medicaid
OHGRCP29481Medicare PIN