Provider Demographics
NPI:1063854677
Name:GRIFFIN, CATHY EVANS
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:EVANS
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CATHY
Other - Middle Name:ANN
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3546
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74402-3546
Mailing Address - Country:US
Mailing Address - Phone:918-304-0840
Mailing Address - Fax:918-752-0547
Practice Address - Street 1:311 DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-4114
Practice Address - Country:US
Practice Address - Phone:918-304-0840
Practice Address - Fax:918-752-0547
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK000000000Medicaid