Provider Demographics
NPI:1073275012
Name:GRIFFIN, AUTUMN R
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:R
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 CLYDE AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-5195
Mailing Address - Country:US
Mailing Address - Phone:216-703-0207
Mailing Address - Fax:
Practice Address - Street 1:4664 LARWELL DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-3621
Practice Address - Country:US
Practice Address - Phone:614-487-7805
Practice Address - Fax:614-487-7809
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician